Generic Drugs -- prescription for a specific manufacturer?
January 8, 2015 7:42 PM   Subscribe

I am currently taking five drugs for which the prescription is "dispense as written."

All five are neurological and/or psychiatric meds, and my doctors are concerned that the minuscule differences between the bioequivalent generics could result in breakthrough seizures and/or depressive episodes.

Needless to say, these drugs are "non preferred non formulary" on my insurance and my copays alone (with 90 day scripts) are running around a total of $600+ for 90 days.

Since the risk here isn't the generic per se, but rather the switch -between- generics, I'm wondering if it's possible to ask my doctors to write a script for -- for example -- 90 days of Teva Lamotrigine 50s. Is this totally insane or is it possible? What's the likelihood my pharmacy would comply?
posted by michellew to Health & Fitness (10 answers total) 1 user marked this as a favorite
When the generic of bupropion I was taking was discontinued, my pharmacy ordered the last bottle they could find and dispensed from it for me until it ran out. My prescription itself didn't say anything in particular; I had just explained to the pharmacists that I felt switching between generics was negatively affecting me and that one formulation in particular seemed to work best. Of course, I would imagine this sort of personalized service is much more likely to happen at a small local shop than, say, Walgreens (where they seemed confused that I asked).
posted by teremala at 8:07 PM on January 8, 2015

When I get generic prescriptions I just tell the pharmacist which brand I want and they give me that one. However, I'm paying cash and not putting it through my insurance, because when my insurance covers this particular med, they think I only need 4 for the whole month. You may run into fiddly insurance issues like that with your meds, but it definitely should not be a problem to ask your pharmacist for a specific brand.
posted by poffin boffin at 8:07 PM on January 8, 2015

I had issues with different generics not working for me. The (informal) research I did seemed to indicate that most pharmacies stick with one manufacturer, so that if you (for example) go to CostCo for X generic medication, you're likely to always get Teva-manufactured X generic medication. It's a gigantic pain, but it may be worth getting paper prescriptions and calling around to the pharmacies to ask who the generic manufacturers for the medications they're dispensing are, and then choosing where to get the prescription filled based on that. If it were me, I'd check at each refill, since a pharmacy could change manufacturers at any point.
posted by jaguar at 8:10 PM on January 8, 2015

CVS wouldn't do this for me, but when I switched to Walgreens last year I asked them to never dispense certain medications if they only had one of the generics I can't take. They immediately made it a permanent part of my file and have promised to notify me in advance so I can have my scripts filled at the other local Walgreens if mine isn't able to comply with my needs in a timely way. Your docs may therefore not have to intervene; just discussing things over with the pharmacist could do the trick.
posted by Hermione Granger at 8:11 PM on January 8, 2015 [1 favorite]

Your docs may therefore not have to intervene; just discussing things over with the pharmacist could do the trick.

This is true in my case as well. I found a pharmacist I like at a local Harris Teeter, and established a rapport with him by dropping off and picking up prescriptions during his scheduled hours. He's so used to seeing me, he probably knows me better than my primary care doctor. Yes, it can be a logistical pain at times, but having someone who is willing to take the time to help me with my meds is priceless.

He never grumbles when I ask him to double-check prices, and will give me the brand name of any prescription I bring, even if my doctor has the generic box checked. I've also requested specific manufacturers of generic drugs, and he had no problem with ordering them.

It would be easier for me to just go to Target, but the line is always 4 people deep, and I just don't feel the same level of customer service.
posted by invisible ink at 8:48 PM on January 8, 2015

I had this experience with birth control pills. I found a generic I liked that worked for me. Their were several other generics for the same brand name and these gave me really bad PMS. I asked CVS to never give me a different generic which they said ok. But pharmacists don't believe there's any difference between generics so they would put any old one in my bag and act confused when I made them go back and fix it. Eventually CVS stopped stocking the one I needed entirely so I had to switch over to Target. Itwas a giant hassle getting this figured out between the high school aged pharmacy workers and arrogant pharmacists. And it definitely will not happen at all if it says DAW on your prescription- I know this from being a high-school aged CVS pharmacy worker.
posted by bleep at 8:57 PM on January 8, 2015 [1 favorite]

...I'm wondering if it's possible to ask my doctors to write a script for -- for example -- 90 days of Teva Lamotrigine 50s.

FWIW, the only time we ever had a problem with a generic, it was a Teva product. It was their generic for bupropion, and it simply terrorized our son. There's really no other way to put it. It made him extremely more depressed and agitated, bordering on suicidal. We ended up having to shop-around various pharmacies in our area, every time we had to re-fill, to find one who was currently stocked with a non-Teva generic (preferably Watson). As long as we stayed away from the Teva version, all was well. Teva, though, is the largest generic drug maker on the planet, so it was hard to avoid, doubly so if you're hooked into your insurer's drugs-by-mail system.
posted by Thorzdad at 7:43 AM on January 9, 2015

I work at a small pharmacy in Ontario, Canada. There are differences in generics, they often use different filler and binding agents which can affect how the drug acts on you. All pharmacies I have worked at can order more than one generic, usually they have access to most of them. It is true we only carry one generic for each drug but I often order different generics for patients at their request. It really isn't that hard, the only trouble you will have is pharmacy staff who aren't willing to do a little extra work and put a note in your file. If that is the case, take your business elsewhere.
posted by drug_dealer73 at 9:39 AM on January 9, 2015 [1 favorite]

Short answer: you should feel free to go back to your doctor(s) and ask for a better explanation of why they don't want you taking the generic. Some doctors pull this move for very silly ($) reasons, and it's a known issue in the world of pharma regulation.

Longer answer: unless you're taking a biologic--and it doesn't sound like you are (correct me if I'm wrong)--there is remarkably little to be concerned about. A lot of the talk to the contrary comes from--surprise!--studies funded by drug companies or orgs with vested interests. It's a complex issue, to be sure, and if you're really looking for drugs that FDA has said specifically are interchangable, Orange Book provides listings of drugs that have been specifically evaluated for precise equivalence. If your drugs are in there, you should also ask your docs for a response (and lamotrigine has a listing). If you want the input of someone other than your physician(s), ask your pharmacist. They often know much more exacting detail about pharmaceuticals than do physicians and can give you a wealth of info to digest on your own, take to your doctor, etc.

(I'm an epidemiologist/toxicologist working in pharma/chemical regulation.)
posted by late afternoon dreaming hotel at 6:06 PM on January 9, 2015

I have had this issue with bupropion xl generics and have switched pharmacies twice due to it. I never knew personalized generic choosing was a thing; I just suffered with what they had. I finally evened out on the Watson Lab generic. They were folded into / bought into by / rebranded as Actavis and I was still okay with that. I had gone from walgreens to costco to target. Target didn't take my insurance so I just pay out of pocket which is like $30.26 for my dose. Not too much different from the former copay and I can function ok.

This is 100% worth taking a stand on and moving heaven and earth to get what you need. I wish you luck.
posted by megafauna at 8:27 PM on January 9, 2015

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