Not What the Doctor Ordered

By: Aimee Hummel, CIS Compliance Manager
aimeehummel@cis-partners.com

With today’s rising healthcare costs, the use of generic drugs has increased dramatically. This is mainly due to the significant cost savings of using generics; for some consumers it can add up to savings of $1,000 a year. Over the last 10 years, generics have saved consumers $734 billion nationwide, according to a report issued in May by the Generic Pharmaceutical Association. [i]

Although the savings are a substantial benefit, there are certain practices being adopted by insurance and prescription drug companies that have demonstrated serious risks. These practices are known as generic and therapeutic substitution, or switching, both of which may cause dangerous health risks and have caused a serious debate in the healthcare industry. Generic substitution is the practice of switching a brand name medication with another medication that is bioequivalent. Therapeutic substitution involves replacing your prescription medication with a different medication – which is often chemically different but expected to have the same clinical effect. [ii]

The problems related to these practices have occurred due to the fact that even though the substituted drugs are considered very similar, they may not be as effective, can have new or different side effects, and may have dangerous interactions with other medications, supplements or food. And making matters worse, the fact that the doctors who prescribe the medicines are not informed of the substitution, increases the risks.

The article referenced below tells a story where a child was given a generic drug used to treat epilepsy even though her doctor wrote “Dispense as Written” on the script. The medication she was initially prescribed had been effectively controlling her seizures. However, after switching to the generic medication, the child suffered 21 seizures that week. [i]

http://www.freep.com/article/20090608/BUSINESS06/906080329/

Since the cost savings show such a huge benefit, yet the risks cause serious concern, it is evident why this has become a heated debate. It seems to me that the best way to remedy the potential risk is to have rules and regulations around drug substitution. Several states have bills in their legislatures, yet no laws have been passed. If there were regulations that required the prescribing doctor’s consent before any changes were made, the potential risk would decrease.
Drug substitution doesn’t necessarily lead to negative outcomes like side effects, decreased efficacy, or dangerous interactions with other substances. “In fact, it is possible that switching to a new medication can result in fewer side effects, better efficacy, and lower costs,” says Sally Greenburg, executive director for the National Consumers League.” [ii]

Consumers must be conscious of their prescriptions and be careful when they are given a substitution. I believe we should have a say in our own healthcare and we must be aware of potential risks.

A helpful resource regarding Drug Substitution information and recommendations by The World Medical Association can be found at the following site: http://www.wma.net/e/policy/d13.htm [iii]

Sources:
[i] http://www.freep.com/article/20090608/BUSINESS06/906080329/
[ii] http://www.sheknows.com/articles/806389.htm
[iii] http://www.wma.net/e/policy/d13.htm
[iv] http://www.ncbi.nlm.nih.gov/pubmed/3731208
[v] http://www.therightprescription.org/site/second/drug_debate
[vi] http://www.epilepsymichigan.org/template.php?pid=96