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Re: Generic Prozac Availibility » fachad

Posted by Cam W. on June 16, 2001, at 22:28:28

In reply to Generic Prozac Availibility, posted by fachad on June 13, 2001, at 15:22:51

Fachad - My experience in Canada, particularily Alberta, is that when generics were introduced about 9 or 10 years ago, third party payers (Social Services, Seniors Benefits, Native Affairs, etc.) all switched to a formulary system. This meant that the third party payer would only pay for the "lowest cost alternative" of a drug; or, in essence, they would only pay for the lowest priced generic form of the drug. Surprizingly, all generic companies ended up having the same lower price.

If a patient wanted the brand name, they would have to pay the difference out of their pocket. This could mean a difference of $50 to $60 a month for a prescription of Zantac™ (ranitidine) or, more common to this board, $15 to $20 a month for Prozac™ (fluoxetine).

Also, many of these third party payers put a cap on the number of days worth of a medication that a patient could obtain. Subscribers to these plans could only get a maximum of 31 days of psychoactive medication (eg antidepressants, antipsychotics, anxiolytics), but 100 days of most heart meds. One of the silly rules was that Social Services would only allow 31 days of haloperidol (a relatively safe typical antipsychotic) but would allow 100 days of benztropine (Cogentin™ generic, an anticholinergic side effects medication used for EPS) which one can overdose on and can cause hallucinations. Sometimes the ivory tower boys (and girls) just don't think. I have never seen any responsible doc write for 100 days of benztropine.

Another problem with formularies is that if a doc writes for a drug not on the formulary, then the drug was not paid for by the third party payer. Therefore, if a new drug was released between April and October (when the new formulary came out), it would not be covered until the next April or October. They have fast tracked this system now, and if a drug is significantly different (read better) from others then they would allow the new drug to be dispensed by special authorization (eg Effexor) or by sending an update sheet to the pharmacies (eg Seroquel). Whether a drug gets fast tracked depends on the skill of that drug's marketing people.

As for substitution to generic, this can be (and was) done automatically, when the new formulary went into effect. We really had no problems and there was little resistance to the change, especially for those who could not afford to pay the difference. There were several generic drug companies so, after a few months, we got to know which were the more reliable and equivalent to brand name drugs. Doctors, at first did write "No Substitution" (had to be in the doctor's handwriting to be honored), but the patient would have to pay the difference. The pharmacist would have to phone the doc and get him to change the prescription if the patient wouldn't or couldn't pay the difference. Nine years later, nearly everyone uses generic.

Really, few drugs were not interchangeable. The one's that I had problems with were a particular brand of salbutamol (Ventolin™ generic) inhaler and a certain generice brand of timolol (Timoptic™ generic) eye drops. The one generic salbutamol inhaler didn't seem to work as well and the generic timolol eye drops caused allergic reactions in some people. Also, generic Valium™ (diazepam) was not wanted by many drug abusers and dealers because they did not bring as high a price on the street.

The brand name companies did not lower their prices in Canada (which would seem the obvious thing to do) because if they lowered their prices here, they would have to do so in other countries, especially the U.S. To get around this, several of the brand name companies formed their own generic companies and sold what were called "ultra-generics". These were exactly the same drug as the brand name, but with different markings on the tablet or capsule. Actually, when making, say alprazolam, the same batch was used to make Xanax™ and the generic equivalent, Alti-Alprazolam. Only the stamp was different. Ya gotta like how big business thinks < sarcasm >.

A little long winded - Cam




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