How to get generic meds when doc said "no substitutions"?
October 20, 2013 5:15 PM   Subscribe

In California, is there a simple way to get the pharmacy to fill my "no substitutions" name-brand prescription with a generic instead? I am temporarily without health insurance and can't afford the very expensive name-brand drug; I can't ask the prescribing doctor to change the scrip because they're no longer my doctor and I'm in a different state.

Background: I take Keppra to control seizures, and it works very well for me. My former neurologist explained that name-brand anti-epilepsy drugs often work better than their generic equivalents, and he always prescribed "no substitutions." My old health insurance covered it, and in a few months I'll have new insurance that is apparently very good and will cover the name-brand. But at the moment, I'm without insurance. I am trying to get some kind of gap-filler insurance to cover catastrophic stuff for the next few months, but I'm finding the application process very confusing. (If only Obamacare had kicked in six months earlier!)

So I don't have a neurologist or a primary care doctor at the moment, and I'm looking at having to refill my three-month prescription in about a month. I know the name brand is very expensive (like $1,000 for three months), and I'm willing to try the generic. But from what I can tell, pharmacists aren't allowed to dispense generic when the doctor specified "no substitutions." Is there a way around this? Or should I be fast-tracking my search for a stopgap insurance policy? (My work would help with the cost of insurance.)
posted by unreadyhero to Health & Fitness (8 answers total)
Have you first tried calling your old neurologist, or even having your pharmacy make the call for you?
posted by Wordwoman at 5:18 PM on October 20, 2013 [1 favorite]

Best answer: Yeah, talk to your pharmacists. They can call the doctor's office and get that changed. It's what they do. (I'm a pharmacy tech. Happens all the time. RPhs are allowed to take new or corrected Rxs over the phone, for the most part.)
posted by themanwho at 5:27 PM on October 20, 2013 [7 favorites]

You should be fast-tracking your search for a stop-gap insurance policy anyway, but first you have to call your old doctor and ask them to fax in a new prescription.
posted by bleep at 5:28 PM on October 20, 2013

generics really aren't all like name brands. especially with neuro drugs. i have first hand experience with the fail of generic topamax. it's for reals. please take that into consideration. if you have a month of your drug left, maybe you can get on the patient assistance program of the drug mfg if they have one.
posted by misanthropicsarah at 5:30 PM on October 20, 2013 [4 favorites]

There are many circumstances where prescriptions can be filled in another state. However, docs don't say no substitute for fun. My concern would be that you need something that is released slowly and the generic just gives you s one-time dump of the active drug.

Talk to the drug company and youroformer doctor's office.
posted by Lesser Shrew at 5:49 PM on October 20, 2013

I would also recommend trying to work on the patient assistance program angle. Like misanthropicsarah said above, changes in medication, even between generic and name brand can interfere with seizure control in sort of unpredictable ways. RxAssist should be able to point you to a program that can help.
posted by goggie at 6:13 PM on October 20, 2013

Best answer: Yeah, there definitely is a patient assistance program specifically for Keppra. I took advantage of it to make sure that one of my patients got her Keppra XR when she couldn't afford it and was between insurances (she is 19). I'd talk to your neurologist and ask them for their help.

Also, frankly, the jury is out about whether brand-name or generic is necessary for anti-epileptic drugs - the FDA ensures that the generic is between 80-120% of the active constituent of the brand name (which is "100%, if you will), so if you don't have bad epilepsy and can afford to have that kind of fluctuation in your blood levels, it doesn't matter as much. But some people have very brittle epilepsy and the consequence of that fluctuation is a seizure which has such consequences as loss of driving privileges for 3-6 months, so a lot of physicians are anxious about it, rightly or wrongly.

In particular, Keppra has 30+ different generic manufacturers, so when you refill, your manufacturer can vary from month to month depending on the pharmacy's deal. And so you can be going from 120% to 80% even month-to-month.

So that's the mental calculus your neurologist is doing. I don't know how brittle your epilepsy is, but those are the facts for you to chew upon too, if they didn't explain this to you in this much tedious detail. I sat down and read the big studies, and ehhh, you have to judge it person-by-person.
posted by vetala at 8:17 PM on October 20, 2013 [10 favorites]

Couple what vetala said with the fact that each manufacturer will have a slightly different process and formulation which can result in different crystal isomorphs. Big deal you say they're still made to a high purity and are identical to only the most sensitive and specific analytical techniques, until it turn out that one isomorph has a lower bioavailability and instead of the drug getting absorbed directly into your bloodstream at a 45% efficiency it instead only gets absorbed at a 15% efficiency so you need to take 3 times the dose to have the equivalent blood dose as before.

It is entirely possible that there aren't any appreciable differences in the formulations, but this is an observable effect across a number of different pharmaceuticals and with something like epilepsy and the other neuro disorders once you find something that works you should stick with it, as opposed to something like an antibiotic where you're only going to be taking it short term it doesn't really matter because you can just switch for the next course if it isn't working.
posted by koolkat at 1:42 AM on October 21, 2013 [1 favorite]

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