Dispense As Written

A few months ago, a pharmacist, a colleague of mine, told me that he was shocked to hear health economists’ open claim about generics. Yes, we firmly believe that brand-name drugs and generics are equivalent. Just like anyone else in the policy arena. FDA says that they are ‘equivalent.’ Express Scripts says that they’re equivalent (see what follows after the star on the picture below). We want cheaper pills. No brainer.

Lately, I decided to start a therapy that puts me on a medication for sometime (that’s why I added a drug coverage during the open enrollment period last year). Although I have had allergies and some other minor health issues since my childhood, none of my conditions have been severe enough to require any special medication. All what I need to do is to pick up a 30-day supply for $4 from Walmart.

This time; that wasn’t the case.

I picked up a bottle of pills from Safeway. I stared at a white plain bottle for a while and started peeling the Rx label with my name on. A large portion of the original label came off with the Rx label, but I could read the name of the manufacturer. Of course, I don’t know the company; but who cares. There is a NDC on it. This is a widely prescribed drug, known to be safe, and indicated for a wide variety of conditions. Not that different from candies, as I walked past a cash register I thought. I threw one tablet into my mouth, swallowed it, tossed the white bottle in my bag, and drove home.

A few hours later, things took an unexpected turn. I started feeling extremely dizzy and had no choice but to spend the rest of the day in bed. Next day, crowing out of my bed, I picked up a few brand-name pills from a reliable source, knowing that some adverse events have been reported for pills that came from some of the generic makers. I needed a bit of time to make up my mind. But, in the end, I decided to take the brand-name pill. I waited hours, expecting another severe adverse event. After almost a day of waiting, I gave up. I didn’t experience any side-effects. Nope. Nada. Never. Was I shocked? I was. That was the moment that the economic theory of equivalency fell apart.

I wrote up a 2-page statement, entitled Urgent Request for Benefit Coverage Review, and asked my PCP to send it over to Express Scripts with her chart notes attached. (They require “step therapy” before covering expensive drugs so my PCP needed to prove that the initial therapy failed.)

My PCP’s assistant submitted our package early in one morning; they approved our request around lunch time. Express Scripts now foot the bill of the brand-name pills which cost them $1,400 per month. The generic ‘equivalent’ costs only $7 per month.