If my doctor says there's no generic, but I can order one, should I?

November 20, 2009 3:02 PM

When nobody seems to think there's a generic for a drug, and yet I can order it. Is this an online pharmacy scam?

Little bit of background. I've been contracting for the last couple years and the last year I was on a contract with a staffing agency that did medical insurance. So, awesome. Until the contract dies and they can't seem to find me any other work.

I'm not sweating it too bad as I've got some irons in the fire, but in the meantime I have no insurance. This is a problem as I take Symbicort for my asthma. Symbicort is expensive and according to Walgreens and my doctor, there's no generic.

But if I check out online pharmacies, lo and behold, there's a generic version. It's composed of two drugs budesonide and formetrol that are both out of trademark protection, so I don't see any reason why someone couldn't mix them and make a generic.

But for obvious reasons I'm sweating ordering it and killing myself. Help me hive mind, you're my only hope!

posted by lumpenprole to health & fitness (17 comments total)

You need to re-think this assumption: "I don't see any reason why someone couldn't mix them and make a generic."

Presumably making a particular drug is not so simple as "mix[ing]" two other drugs and selling that combination as a generic.

Just because some internet search indicates that there is a generic form of a drug out there does not mean that there is actually a generic form of the drug out there.
posted by dfriedman at 3:08 PM on November 20, 2009

The patent on Symbicort doesn't expire until 2012.
posted by Sys Rq at 3:09 PM on November 20, 2009

Pharmacist here: Putting two drugs together in a single inhaler is more complicated that just mixing them together. In order to manufacture a combo-product, it has to go through testing to see that the two drugs are compatible together and to make sure that when you inhale the drug, you're getting the correct doses of medication. Symbicort just came on the market only a couple years ago, at best, so it's still protected by U.S. patent, and no, there's no generic. It might be possible that the online pharmacy is just listing "Symbicort" under the generic names. If they really are trying to sell you a generic product, I'd be wary, for your safety.

Have you tried calling AstraZenica to see if you qualify for their prescription assistance program? Sometimes, uninsured or underinsured people who don't qualify for Medicare/Medicaid can get help from the drug companies.
posted by watch out for turtles at 3:13 PM on November 20, 2009 [4 favorites]

The short answer is that there's no generic Symbicort-alike in the US because AstraZeneca has the patent on it here-- but the patent in the European Union was revoked.

Wikipedia seems to indicate that the Symbicort inhaler setup between the US and EU versions is different, though-- the US one is a metered-dose inhaler and the EU one is a dry-powder inhaler. I don't know what manner of inhaler you'd get with a generic budesonide-formetrol formulation, or how it would work for you. Perhaps some MeFite with COPD or asthma in the EU would know more?
posted by fairytale of los angeles at 3:16 PM on November 20, 2009

Other countries do not necessarily have the same intellectual property laws towards pharmaceuticals as the US. Check where the product you're looking at is being produced.
posted by larkspur at 3:16 PM on November 20, 2009

It can be the case that a drug which consists of two drugs that are no longer protected by patents is itself nonetheless covered by a patent related to the manner in which those drugs are combined. As dfriedman pointed out, combining drugs is not necessarily straightforward and various techniques for doing so can result in patent protection.

IANAD. It may be possible for your doctor to prescribe the two component drugs for you to take you take separately (that is, to take them at the same time but not pre-combined), or it may not.
posted by onshi at 3:18 PM on November 20, 2009

Three websites that may make this situation more clear: Symbicort is currently protected by a patent, which means that other drug companies cannot manufacture generic Symbicort until it expires. Because the active ingredient of any drug is often referred to as its "generic name," many people are under the impression that budesonide and formoterol are generic forms of Symbicort. However, these are actually the active ingredients of the drug and are not generic Symbicort.

Generic drugs can be legally produced for drugs where: 1) the patent has expired, 2) the generic company certifies the brand company's patents are either invalid, unenforceable or will not be infringed, or 3) for drugs which have never held patents.

Budesonide/formoterol is a combination formulation containing budesonide and formoterol used in the management of asthma and chronic obstructive pulmonary disease (COPD) in the EU. It is marketed by AstraZeneca under the trade name Symbicort. Symbicort in the United States is a metered-dose inhaler^{[citation needed]} while in the EU, Australia, Canada, Israel, and elsewhere Symbicort is available as a dry powder inhaler.
posted by filthy light thief at 3:20 PM on November 20, 2009

If you are looking to online pharmacies then I'd lean very, very strongly towards scam. But I'm a cynical bastard so what do I know?
posted by fenriq at 3:21 PM on November 20, 2009

I am a pharmacy student going into my last semester of school. I have also been working in a pharmacy for the past five years.

As strange as this may sound, a combination of two drugs can be patented as a separate medicine. Symbicort is a combination of a steroid (budesonide) and a long-acting beta-agonist (formoterol). It is true that these drugs are available separately, but you cannot get them in a single inhaler without using the brand-name product.

You could potentially use budesonide and formoterol seperately if you talk to your doctor about the possibility. I would not, however, recommend that you order from an online pharmacy without a prescription since those drugs may be counterfeit, diluted, or adulterated.
posted by verapamil at 3:22 PM on November 20, 2009

IANAD. It may be possible for your doctor to prescribe the two component drugs for you to take you take separately (that is, to take them at the same time but not pre-combined), or it may not.

This is a good thought and one I was going to suggest as well. However, to my knowledge, formoterol (Foradil) is still a branded product and so might not help with the cost issue...
posted by watch out for turtles at 3:28 PM on November 20, 2009

I hope this isn't too far afield, but if you could somehow get insurance, it might be the worth it because Symbicort is so expensive and you don't want to get hit by an existing condition exclusion that will keep you paying for the Symbicort even after you have insurance.
posted by kathrineg at 3:29 PM on November 20, 2009

but if you could somehow get insurance,

That's just not a possibility. Insurance is more than flat out buying the Symbicort.
posted by lumpenprole at 3:32 PM on November 20, 2009

If you qualify, you may want to check out the Prescription Assistance Program for Symbicort. Should you be eligible, they will outright give it to you for free.
posted by zachlipton at 3:47 PM on November 20, 2009 [1 favorite]

Also, insurance may be more than flat out buying the drug, but it does confer a number of important other benefits, such as paying for your health care should you become ill, and sooner or later, you most likely will take ill. It's absolutely understandable if you just can't afford insurance under any circumstances, but just because health insurance costs more, it doesn't mean it's not worthwhile.
posted by zachlipton at 10:17 PM on November 20, 2009

It's not at all the same drug, but just to let you know my doctor just warned me today that I may have issues switching from brand-name Effexor to its generic, venlafaxine. So don't just assume you can take the 2 generic forms with no problem. Talk to your doctor. Maybe there's a cheaper alternative to Symbicort that he/she can switch you to?

Seconding the Patient Assistance Program... it's worked for me in the past.
posted by IndigoRain at 12:39 AM on November 21, 2009

I'd be super leery of this. If what your getting is a generic European version that's probably OK, assuming the European formulation works for you. (Note - I'm talking safety wise here - I have no idea what the legalities are.)

Now the scary, Kid Charlemagne is a pawn of big pharma part: There are places where they could care less about US intellectual property law (or putting melamine in milk or padding out their heparin with oversulfated chondroitin sulfate). What I'm trying to find right now is an image of a western blot probed with anti-E. coli host cell protein antibodies showing human growth hormones from two companies you've heard of (I get a paycheck from one) and a bunch that you'd be hard pressed to pronounce. Two of the lanes were squeaky clean (there are doubtlessly impurities, but they're present below the detection limit of the method) the others all had numerous bands in them which means they had multiple E. coli impurities present at detectable concentrations.

I'd love to include a link but my Google Fu is failing me. If anyone wants to go digging for this - I know this image was presented by Robert Garnick some time back, but I can't find it anywhere on-line.
posted by Kid Charlemagne at 10:34 AM on November 21, 2009

Just fyi, I went with the symbicort, tho through an online dealer. I am much relieved.
posted by lumpenprole at 2:24 PM on January 13