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Pharmacy policy of switching you to generic- Walgreens

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Initial post: Mar 16, 2008 8:28:56 AM PDT
ebaymom says:
Has anyone else encountered this? The practice of a pharmacy automatically changing your prescription to the generic form without your consent regardless of whether or not your isurance has authorized the name brand? I have private insurance, personally, I think it is my choice to decide whether I want generic or name brand anything. Given the option of knowing that the amount of payment from my insurance carrier is the exact same amount either way...I'm taking the name brand. Call me an an elitist- whatever. I earn my full salary with benefit package. I didn't even know what it was they gave me- they never even told me that they medication was a "generic form of". I was in such a hurry to get it home to my sick child, I didn't even look. I just assumed it was what the urgent care doctor told me it was that he was calling in. When I got home, I had to look up what it was and then called Walgreen's (last time I'll ever go there!) to hear that is their standard practice and that they reaceive bonus/incentive money to do so.

Any pharmacy people out there who can shed light on this? Anyone else had this experience?

In reply to an earlier post on Mar 16, 2008 8:37:18 AM PDT
What is your reason for not liking generic? The active ingredients are EXACTLY the same.

In reply to an earlier post on Mar 16, 2008 8:38:26 AM PDT
Firefly says:
Most pharm do this. There is a place on your doctor's prescrition pad that he can sign for no substitutions or to allow selection. You need to talk to him. At least that's how it works in TX.

In reply to an earlier post on Mar 16, 2008 8:39:12 AM PDT
J. Davis says:
Whether you know it or not this is probably your insurance company's policy. They prefer generic drugs because it costs them less. You should have checked the drugs before you even left the pharmacy, it can be dangerous not to. I'm sure that Walgreens will not miss your business.

In reply to an earlier post on Mar 16, 2008 8:49:34 AM PDT
ebaymom says:
Our previous experience with a generic switch was this: my husband is taking protonix and was switched (not by the insurance but by the pharmacy) three months back. We figured it WAS the insurance company and that is WAS the same and didn't argue despite the fact taht he had been taking the medication for over 14 months at that point. After 6 days on the generic equivalent, he had all sorts of side effects: chronic cough, chest pains, bloating, gas, etc. We had no idea what was wrong. I kept going back into our pharmacy to get more OTC stuff until our regular pharmacist asks me why I was there so frequently. He's the one who put two and two together- we looked up the side of effects of the generic protonix and sure enough, people were having the same symptoms. He stopped immediately and felt better within a week. This after 2 months!

J. Davis: I checked with my insurance company. I'm double-covered. They prefer me to use the generic if one is available, but at this time do not require it. Yes, I should have checked before I left. I agree. Thankfully, I checked when I got home and drove back. I could have saved myself a lot of time. You're right- Walgreen's doesn't care. It's all I can do though- take my private insurance elsewhere.

In reply to an earlier post on Mar 16, 2008 8:59:11 AM PDT
Sue A. Brant says:
I agree with you, I like brand name drugs. This actually happened to me at several places for my Flonase. I get lots of scripts, but the generic didn't seem to work as well for Flonase. I don't think it's psychological. I once told them I wanted brand name, always, but they kept forgetting. The solution is to ask your doctor to check the box DO NOT SUBSTITUTE or always tell them at the pharmacy when you turn it in. Otherwise you may have this happen anywhere. Sorry. It is a pain but that's the way it is. It used to be the other way around. These days with drug costs skyrocketing, drug plans like generic and people like the lower co-pay more often than not, so the tide has turned on those of us who like brand name drugs.

In reply to an earlier post on Mar 16, 2008 9:08:23 AM PDT
New mom 2014 says:
Its not just Walgreen's policy, its all pharmacies and usually it is state law that you are provided with a generic if there is one available. If they didn't, then you'd accuse them of overcharging seniors or something because they don't know better a lot of the time. Something else you should remember about brands vs. generic... some of the medications out there have been out so long, the brand is no longer made or available. Some examples are amoxicillin, penicillin, hydrochlorithazide... some of these I wouldn't even be able to tell you their brand names anymore. It's all in your head that brands work better.

In reply to an earlier post on Mar 16, 2008 9:21:31 AM PDT
ebaymom says:
How about this solution: "There is a generic version available of that drug that may save you money. Would you like that option?"
I just want the choice, not to be forced. If I want to buy Kraft American cheese slices and not the generic equivalent, that is my choice- not the grocery store's.

In reply to an earlier post on Mar 16, 2008 9:37:56 AM PDT
Just want to back up what your sayin. i want the choice. I should ba asked not assumed.

In reply to an earlier post on Mar 16, 2008 9:47:04 AM PDT
Emily B. says:
ebaymom: I agree with you--the active ingredient might be the same in a generic, but the brand name drug's other ingredients often make the medication easier to take and go down more smoothly.

In reply to an earlier post on Mar 16, 2008 9:52:40 AM PDT
As far as ALL generics being equivalent to the original brand name drug they're replacing, studies have been done that refute that idea. Quality control in the manufacturing plants, and FDA oversight of foreign manufacturers is inconsistent. Read the following link from the Washington Post, and others: article/2007/06/16/AR2007061601295_pf.html -
Title: FDA Scrutiny Scant in India, China as Drugs Pour Into U.S.

Excerpt: "Over the past seven years, amid explosive growth in imports from India and China, the FDA conducted only about 200 inspections of plants in those countries, and a few were the kind that U.S. firms face regularly to ensure that the drugs they make are of high quality.
"The agency, which is responsible for ensuring the safety of drugs for Americans wherever they are manufactured, made 1,222 of these quality-assurance inspections in the United States last year. In India, which has more plants making drugs and drug ingredients for American consumers than any other foreign nation, it conducted a handful. . . .
"As the manufacturing goes to China and India, the risk to human health is growing exponentially," said Brant Zell, past chairman of the Bulk Pharmaceuticals Task Force. The group represents American drug-ingredient makers that filed a citizen's petition with the FDA last year asking the agency to oversee foreign firms more aggressively.
"'The low level there' of follow-up inspections, 'combined with the huge amount of importing, greatly increases the potential that consumers will get products that have impurities or ineffective ingredients,' he said." ENDQUOTE


and further proof that all generics are not made equally--this from the UK:
>>The MHRA has issued a Class 2 alert to recall Chatfield brand amoxicillin suspensions expiring in August 2007 and Dedoxil brand amoxicillin capsules expiring on or before May 2009. Pharmacists are requested to quarantine any remaining stock and return it to their supplier for credit. The Agency reports that there are concerns about the quality of active ingredients used in manufacture. . .
Amoxicillin is a generic drug i.e. an off-patent drug which may be manufactured by any company anywhere. Patients should be aware that the Department of Health is actually fining GPs huge sums for *not* prescribing sufficient of these generic drugs. This is not the first faulty generic drug to be withdrawn after being prescribed to patients. There is also the high risk of generics being deficient in quality due to being counterfeits.<<

In reply to an earlier post on Mar 16, 2008 10:15:29 AM PDT
You do know that your dr can write the scrip with an "x" on a box that says do not substitute.

In reply to an earlier post on Mar 16, 2008 10:41:28 AM PDT
ebaymom says:
I do know that you can ask to have that box marked, yes. I do appreciate the research that went into the previous post from Chantal Ritz. There are some antibiotics that I am sure may be exactly the same, but there are other "equivalents", that just are the equivalent. And I believe that the pharmacies getting kick back/bonus money is the true motivator here. If I'm really being honest, I would admit that I think earned the right to make my choice by having private insurance, which technically I "pay" for as part of my salary compensation. Nobody is funding my insurance with tax dollars; my job pays me salary and benefits and part of that benefit package is negotiated every year. Currently my husband has to pay additional money over what his employer allows each money (money over the cap) for the higher plan. We pay for the extra coverage so that we can get the best medical care and coverage. That means I want the best medicine available too.

In reply to an earlier post on Mar 16, 2008 12:31:01 PM PDT
schoolgirl says:
I take generic in everything except my thyroid med. My nurse practioneer had said that there was one med. she liked the name brand on and it was that.At the time I was taking the generic, my legs and feet got to hurting so bad I thought I was developing arthritis. She gave me samples of the name brand and my legs got so much better.When my ins. wouldn't pay for the name brand I started taking the generic again and started hurting again. I am on the name brand now but having to pay for it. The one good thing is that the script was for 90 days, so 62.99 wasn't too bad for 3 mos. Faye

In reply to an earlier post on Mar 16, 2008 12:32:09 PM PDT
There are a number of factors involved here:

1. State laws on substitutions differ.
2. Insurance policies differ.
3. Pharmancy policies differ.
4. Your own doctor's preference affect this, too.

If your doctor specifies a brand name, no one can *force* you to switch to a generic. In some situations, someone's default policy may be to switch you without asking, but there will always be ways to insist that a substitution not be made.

Your doctor may have a preference to certain name brands over generics for a number of reasons. He or she should be familiar with what is required in their state to make it be known that they do not want a substitition to be made, as opposed to just using the brand name over the generic name for convinenince.

Your insurance company is looking out for their bottom line. They just want you to get what costs them the least. You might have a policy in which their share is the same dollar amount whether you get generic or a brand name, but under most policies, they're paying more for brand names than generics.

(Note that your insurance company may also have a formulary that encorages, or even requires the substitution of "equivelent" drugs. That's not the same as substituting a generic, and is an entirely different discussion. For example, giving you Claritain when Allegra was prescribed is NOT substiting a generic. It's substituting a completely different drug. These kinds of changes are almost always initiated by the insurance company, not the pharmacy.)

The pharmacy may also have a policy of subsituting generics for name brands as a cost savings measure. If that's their policy, even though they're trying to increase their margin, they'll also let you know it's their policy, spinning it to say they work to save you money. This practice isn't always allowed under state laws, but it may also be encouraged by state law, too. Your best move: Ask.

State laws are a mixed bag. Some laws are passed to benefit the insurance companies. Some to benefit the pharmicuticle industry. Some are even passed to proect the consumers. However, many laws have unintended consequences, too.

All that said, as the patient, it's our responsiblity to ask the doctor questions about any prescription. Asking about generics vs name brands, as well as equivelent choices should be part of the discussion. Take a copy of your insurance company's forumulary with you to any doctor's appointment. If your doctor wants to prescribe something off-formula, understanding why, and what effect that will have on you (financially as well as medically) should be discussed.

Whatever your state law, or insurance company policies, if the doctor is very insistant on no generics, he or she needs to make sure that's on the prescription.

Ask at the pharmacy when you drop off the prescription about what their policies are, and what you need to do if you want treatment other than their default. Go to a different pharmacy if they won't have this discussion with you.

When you pick-up your prescription, look to see if any substition was made, and question why it was made. It may be that they called your doctor to discuss it. If that's the case, then your discussion should be with your doctor. If they made the substitution based on the instructions of your insurance company, ask what it would cost you to ignore your insurance company's direction.

Ultimately, if you don't want a subsitution, you're going to need your doctor to be behind your choice. Without your doctor behind you, you may be stuck.

In reply to an earlier post on Mar 16, 2008 12:50:23 PM PDT
ebaymom says:
Warren- that was the best damn post I've read on this subject. I could have saved myself hours of phone calls and driving if I'd read what you wrote a day ago. I pretty much discovered for myself what you said after phoning the two different pharmacies, my doctor, the Urgent Care Clinic who prescribed, and looking at my policy.
In short: if the doctor checks "do not substitute", then my policy will pay. If not, they expect the pharmacy to substitute what they believe to be a generic equivalent or I will be expected to pay a higher premium price. I will now ask every time when given a prescription, "Is the generic form of this drug EXACTLY the same?" If not, then I don't want it. One bad experience is enough. If it is the same composition, then I'm fine with saving everyone involved money.

In reply to an earlier post on Mar 16, 2008 12:54:05 PM PDT
Melissa P says:
I am a pharmacy technician in MN. In MN it is state law that if a generic medication is available and in stock that the customer automatically be switched to generic unless the doctor states that the name brand is necessary or the patient specifically requests name brand. Even under these circumstances not all insurances will pay for the name brand, or a prior authorization is needed to prove that name brand is medically necessary, and that can take weeks depending on the insurance company. Some insurances switch their formulary as soon as a generic comes out and others wait a few months. Most pharmacies do not even carry the name brand form of a medication(unless they have a customer chronically on them) if there is a generic available because most insurance companies don't cover them and it is not cost effective. In your case the difference between a name brand antibiotic and the generic could be a hundred dollars. (wish i was joking but i'm not) It's not exactly an easy process on the pharmacy end. At the pharmacy I work at we always try to make sure that we inform the customer when switching them from a medication that they have been on, especially since the generics don't always look the same which can be confusing.
I don't work at Walgreens (thank god) but we do not receive bonuses or incentives to switch customers at our chain. We are just required by law and it is incredibly cheaper for the customer to have a generic medication. And like Polly Ester said, all the active ingredients have to be exactly the same.

In reply to an earlier post on Mar 16, 2008 1:06:58 PM PDT
M. Thompson says:
What you are claiming is impossible due to the fact that "generic" Protonix is actually made by the same drug manufacturer as the brand name (Wyeth). Lederle's pantoprazole actually has "Protonix" as an imprint code which would only be possible if it actually was made by Wyeth. Yes, differences in manufacturing can result in different therapeutic responses but only very rarely (levothyroxine, digoxin, & warfarin to name the more common ones). The more important point with these is not to switch back and forth between different brands. Stabilize on one brand and stay with it. A good pharmacist will not switch your brands on these select few. Remember also that many, if not most, insurance carriers will only cover the generic. If the customer or the physician requests brand name only, the insurance will not cover it or will throw it into a much higher deductible. Don't blame your pharmacist. He's only making a couple of dollars either way regardless of what the final price is.

In reply to an earlier post on Mar 16, 2008 4:50:51 PM PDT
zipper says:
Having worked for a major pharmaceutical company, I know that the generic brand has the same "Active" ingredient. First, what is different is the fillers that they use. How the tablet or capsule is made. Second, pharmaceutical companies MUST Prove that their new medications are a viable dosage. That means that what the body uptakes is the needed amount. Generic companies DON'T have to prove that. This is key. So if you take a generic, your body may be getting more or less of the "active" ingredient. When in doubt make sure your doctor checks the box on the prescription pad that says "do not substitute" and have that serious talk to him/her about your medications. I take several and they are all name brand. But I also have and insurance plan that gives me the option for either, my choice. I also had a run in with Walgreens. They substituted my heart medicine. I was furious and had them change it to name brand. If I am taking something that keeps me alive, I make sure that it is "Name Brand" as prescribed by my doctor. Bottom line, however, talk to your doctor not a blog.

In reply to an earlier post on Mar 16, 2008 5:04:08 PM PDT
Last edited by the author on Mar 16, 2008 5:19:07 PM PDT
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In reply to an earlier post on Mar 16, 2008 7:15:12 PM PDT
Lily says:
"Really, the only differences between the brand names and the generic versions are appearance and price. The drugs ARE the same thing just diferent names."

If they appear different, something is different.

If you put water in a baloon, as soon as you puncture that balloon, you're covered in water. If you put water in a basketball, you can puncture that basketball, but barely get wet. Same active ingrediant: Water. Different appearance of the delivery system.

Extreme example, yes, but only to prove the point: If it looks different, something *is* different. And that difference can make a big difference in some cases.

Am I saying that every brand name is better than the generics? No. Sometimes it doesn't make a significant difference. But sometimes it does. Sometimes there's even a difference between generics.

It doesn't have to be a huge difference, and just because there's a diffference doesn't mean it *makes* a difference. For example, prescription Priolsec and OTC Priolsec are different. One is a capsule, and the other a capplet, a major manufacturing difference that results in a number of different ingrediant differences. For most people, it probably makes little to no difference. But to some people, it's the difference between a pill that works, and one that doesn't.

Doctors aren't infallable. In any given case they might be right or wrong in whether it makes a difference. But of all the entities that can make a choice between a brand name and a generic, who do you think is most qualified? You? The pharmisist? The insurance company? A state legislator? Or the doctor?

IMHO, the pharmisist may know more about the drugs, but the doctor knows more about the patient. The pharmisist, if he thinks he has significant information, can call the doctor, but the doctor's judgement trumps his. If the pharmisist isn't using his own training and experience to make a judgement, but rather is just following some "policy", that's just wrong. The insurance company gets to decide what they'll pay for as long as they've disclosed how they'll be making their decisions ahead of time, and their policy is not not morally or ethically unconcionable. And you get to decide how you spend your money. (The state's only part in this is to protect your right to choose, and to ensure that you have access to enough information to make an informed choice.

Anyone who says they always/never want the brand name over the generic or vice versa, is making an uninformed choice. Sometimes it matters theriputically. Sometimes it doesn't matter theriputically. Sometimes we can't afford the best theriputic choice, but we should be the ones who make that choice in conjunction with our doctor, not the pharmacist or the legislature.

In reply to an earlier post on Mar 16, 2008 7:21:54 PM PDT
A. Thomas says:
Drugs are bad. Mmmmkay.

In reply to an earlier post on Mar 16, 2008 7:46:11 PM PDT
Last edited by the author on Mar 16, 2008 7:46:57 PM PDT
Katie Kate says:
Why not nip the whole thing in the butt and just ask them to fill it with the name brand? They will, that is, if you really are paying cash and your insurance company isn't insisting on it. It would be fixed in 15 minutes. Honestly, switching people to generics is the socially responsible thing to do. Why waste health care dollars when you don't have to. I understand in your situation, you may desire the brand name, and are willing to pay for it, and that's fine. That, however, isn't the case with most people. My husband is a pharmacist and you will not find a brand name drug anywhere in our house!

In reply to an earlier post on Mar 16, 2008 8:31:04 PM PDT
Last edited by the author on Mar 16, 2008 8:32:18 PM PDT
PC Guy says:
They just had a medical report on TV about people like you. Brand name pills may actually make you feel better, It's called the placebo effect. If people pay more for a drug they think it must be better and they feel better. In other words it's all in your head. When blindly tested against generics the results were about the same. I'm glad I'm not on your group health plan, I save literally thousands of dollars a year buying generics and cannot tell the difference, that is if they are true generics and not just a similar acting pill. I hope that health insurance carriers continue to increase the reward for using true generics (charge lower co-pays) until you pay the entire difference. Your bias not only costs you more money, it costs the people in your plan more in premiums. You have the right to ask for brand name drugs of course. My pharmacist at CVS always asks. If you do some research and talk to your Dr. you'll find that generics are the same. There are exceptions and your Dr. will tell you if there is one. Remember though, your Dr. is incentivized to give you the lastest drugs advertised on TV even when an old standby will do, because you will then think he is really up on his stuff or many people outright request the advertised drugs and he will comply if they are warranted for your condition so you won't think poorly of him and sue.

In reply to an earlier post on Mar 16, 2008 9:05:34 PM PDT
E. Morgan says:
**There is a box at the bottom that he or she has to mark if it's okay to substitute generic.**

Not quite true. There is a box at the bottom that the doctor has to mark if it's NOT okay to substitute generic.

The default is "generics are okay." The doctor has to make a special note if generics are NOT okay. Because generics ARE okay for most people, most doctors get into the habit of never bothering to check that box, or even think about it one way or the other.

The patient needs to be informed, observant, and vocal about his or her preferences and/or needs - otherwise the doctors and pharmacies will just go with the SOP, which today is generics.

Personal experience with generic inconsistencies: Generic Vicodin makes me high as a kite. Generic Lortab in the same strength does not. Generic Vicodin is hydrocodone/APAP. Generic Lortab is also hydrocodone/APAP. The pills appear to be identical as far as I can tell.

I was very reluctant to take the Lortab, because I completely expected to get high from it (addiction runs in my family and I prefer not to take chances) - I had gotten buzzed on the Vicodin and knew that the ingredients in the Lortab were the same. Placebo effect would indicate that, expecting to experience a high, I would have done so. But I didn't.

Some time later, I took what I thought was the generic Lortab, expecting that I would *not* get high. Turns out it was the generic Vicodin, when I checked the bottle after the room stopped spinning.

The only thing I can think of is that the machinery at the manufacturing plant must have been miscalibrated and putting either more or less of the hydrocodone into the mix than it was supposed to for one of them, because the ingredients list is the same, the dosage is the same (7.5/500 on both), the pills look identical, and yet one consistently sends me to lala land while the other doesn't. Go figure.
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Discussion in:  Gold Box forum
Participants:  92
Total posts:  178
Initial post:  Mar 16, 2008
Latest post:  Nov 6, 2012

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