POZ Community Forums
Meds, Mind, Body & Benefits => Research News & Studies => Topic started by: james3000 on January 15, 2013, 07:47:37 am
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This was in the news today.
http://www.bbc.co.uk/news/health-21012160
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I've taken the Subutex generic when i was coming off H and it's nothing like the real thing. Much less effective and i'd have to take bigger dosages.
In the UK it's at the pharmacist's discretion [at least in my area] so i asked them not to give me generics and that was the end of it.
But for example when i lived in Portugal, it's the Doctor himself than prescribes [or not] generics. Most people there wanted them coz they're cheaper.
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I'll wait for a paper from a medical journal on the issue rather than something like the BBC.
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I'll wait for a paper from a medical journal on the issue rather than something like the BBC.
A study led by Massachusetts General Hospital (MGH) investigators, appearing in the January 15 Annals of Internal Medicine, examines the potential impact of such a change.
There is a more detailed article explaining this issue in Science Daily.
http://www.sciencedaily.com/releases/2013/01/130114172056.htm
From my undestanding, correct me if I am wrong, is that this concern stems from a previous study which stated that people who took their HIV medication as one pill (such as atripla) had better adherence and therefore did better overall.
When people had to go from a one pill combination, to taking their medications seperately in their individual components their adherence dropped affecting their health in the long term.
I dont think the actually checmical componants of a generic medication are inferrior to the brand name, at least not in the US. The FDA assures that. The "news" covereage of this doesnt clearly explain this.
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From my undestanding, correct me if I am wrong, is that this concern stems from a previous study which stated that people who took their HIV medication as one pill (such as atripla) had better adherence and therefore did better overall.
Actually there was a study on aidsmap several months ago that said this wasn't really the case.
http://www.aidsmap.com/Dosing-frequency-and-number-of-pills-dont-affect-HIV-treatment-outcomes/page/2530789/
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Actually there was a study on aidsmap several months ago that said this wasn't really the case.
http://www.aidsmap.com/Dosing-frequency-and-number-of-pills-dont-affect-HIV-treatment-outcomes/page/2530789/
Maybe that was the article that I read, I know it was recently. For some reason I thought it did affect adherence not the other way around. The article that you posted would clearly contradict this paragraph from the science daily article.
"Replacing two of the three branded drugs with generics could significantly reduce costs, the authors note, but such a strategy would also have disadvantages. A more complicated treatment regimen, requiring three daily pills instead of one, increases the risk that some patients will miss doses, leading to the loss of antiretroviral effectiveness called treatment failure."
Isnt it interesting how two articles say exactly the opposite.
I know we have discussed this many times on the forums before. How do you feel if your insurance compay (or govt insurance) told you you had to switch off your brand named combo (atripla/stribild whatever) and would only pay for individual generics? There is something about that that doesnt sit well with me. I just dont like it.
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I don't understand people who complain about the sky high cost of medical care, but then conversely don't want to take generic medication.
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I don't understand people who complain about the sky high cost of medical care, but then conversely don't want to take generic medication.
Considering the enormous waste in the US healthcare system and our system of having private, for profit, insurance companies as middle men, I don't understand people that think the way to cut costs is to limit a patients treatment choices. I can think of numerous ways to cut costs before I would change a patients care. ;D
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limit a patients treatment choices.
Where's the limiting? Generic drugs have not been shown to be inferior. You're just making stuff up. Aren't you a lawyer?
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Where's the limiting? Generic drugs have not been shown to be inferior. You're just making stuff up. Aren't you a lawyer?
I don't have a problem with generic drugs per se. I take a generic high blood pressure medication.
However, when you deconstruct a combination therapy to its seperate components that could be argued as a change in treatment. Also, when only 2 of the 3 medications are available as generic requiring the patient to change the third drug, that is definately a change. My treatment is being limited by a third party, for profit company whos primary interest is not my health and well being but is instead delivering profits to even more distant shareholders (who really dont have my health and well being as their primary interest). There is an argument there.
Until the combination treatment is itself available as generic (such as a generic Atripla pill) then there is an arguement that changing your treamtment due to the wishes of your insurance company, is limiting.
You're just making stuff up. Aren't you a lawyer?
I dont think I am making anything up. This study conducted by Paul Sax:
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0031591
stated that patients who have a lower pill burden (take fewer pills to treat their hiv) may have improved adherence and clinical outcomes.
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How do you feel if your insurance compay (or govt insurance) told you you had to switch off your brand named combo (atripla/stribild whatever) and would only pay for individual generics? There is something about that that doesnt sit well with me. I just dont like it.
It wouldn't bother me in the least - in fact I would welcome it.
I take a total of six different meds every single day. The only ones that aren't generic are the hiv ones. The generic meds I take are every bit as effective as the equivalent name-brands.
I'm also currently on an antibiotic - also generic. And if I happen to develop thrush from the antibiotic (I often do), I have generic fluconazole on hand to deal with it.
I actually don't like it when I'm given a name-brand drug when a generic is available. I prefer to know that health-care costs are being cut, thereby allowing more people to have good medical care.
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The study seems to pinpoint the drop in effectivity of generics down to adherence. Now what I don't get is that if you switched from Atripla to three different pills, do you need to have three different dosing schedules as well? One before meals, one after meals, one before bedtime? If not, then I don't see a problem taking 3 pills once a day at the exact same time.
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It is the same active ingredient in both the brand name and the generic. In many cases you are paying for the marketing costs.
I once worked for a big brand name candy company. I was shocked when a no name brand order was placed. It was the same product in no name packaging! LOL
Best to all.
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The study seems to pinpoint the drop in effectivity of generics down to adherence. Now what I don't get is that if you switched from Atripla to three different pills, do you need to have three different dosing schedules as well? One before meals, one after meals, one before bedtime? If not, then I don't see a problem taking 3 pills once a day at the exact same time.
Nope, the meds in the one-pill combos can be taken all at once, regardless of how many pills are involved. The combo I'm on entails four pills once a day. I chuck them down my throat all at the same time, just like I would if only one pill was involved. Maybe I'm missing something, but I don't get what the big deal is. ???
It is the same active ingredient in both the brand name and the generic. In many cases you are paying for the marketing costs.
I once worked for a big brand name candy company. I was shocked when a no name brand order was placed. It was the same product in no name packaging! LOL
Best to all.
'Zactly. You pay for the name - and the copyright.
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Back in the olden days of sustiva my doctor seemed to be doing the happy dance when he switched me over to Atripla , kinda like I was going to get sliced bread for the first time . I joked with him about how was I going to manage all the new spare time coming my way and thanked him from sparing me certain death lurking around every corner from a two pill burden . I think I ruined his moment .
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Back in the olden days of sustiva my doctor seemed to be doing the happy dance when he switched me over to Atripla , kinda like I was going to get sliced bread for the first time . I joked with him about how was I going to manage all the new spare time coming my way and thanked him from sparing me certain death lurking around every corner from a two pill burden . I think I ruined his moment .
Meanie! ;D
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i do think Bug has some valid points.
i'm tired of being pushed around by the greed of big pharma and insurance companies.
Larry Kramer would be and still is pissed!
and rightfully so.
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After back surgery, I got brand name pain meds. I eventually had to get a generic made by a company called Watson. I found these just as good. However, many pharmacies began using a different generic, made by a company called Mallickrodt. I found it seemed like I was taking a placebo. My pain was no longer being helped.
I thought perhaps it was just all in my head, even though I didn't think that about the other generic. One day, the pharmacist asked me what I thought of the new generic. I told him my complaint. He said they had gotten several complaints. I would talk to patients at the neurosurgeon's office, and they would say this generic, most pharmacies had switched to, was inferior.
When I told the pharmacist that generics have to be the same, he said that's not quite true. They have to have the same active ingredients, but the fillers can make the difference. He believed the fillers in this new generic were causing the active ingredients to not be metabolized properly. This is exactly how it felt-- it was taking forever to break down that the med was being released very slowly. I felt if I ever needed life-saving meds, this would be a consideration. My mom takes Coumadin. When she took the brand name, her INR lab was always good. When she took the generic, it was always off and the med needed to be adjusted.
Of course, this is just anecdotal. And, of course, most generics work just as well. But, the pharmacies obviously switched because this generic was cheaper over the other generic, and probably offered a higher profit margin. I believe the lower cost equaled poorer quality, in this case. I went online and found numerous complaints. In fairness, there were some who liked this generic, but I would say it was 20 to 1.
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Always appreciate these articles but sometimes I start to wonder whose publishing them. Maybe I'm being totally dense but I read this in the Wash Post and with a statement like this, this article seems to have lost a lot of credibility:
At the same time the lifetime financial savings would be $42,500 (£26,500) per patient, say the Massachusetts General Hospital investigators.
My generics cost $225/month (for all three, including shipping costs). The same brand name combination retails for about $1600/month. Do the math. I save almost $17000/year. Even using the reduced prices ADAP pays, the number still don't add up. What gives? I think they dropped a zero!
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Until the combination treatment is itself available as generic (such as a generic Atripla pill) then there is an arguement that changing your treamtment due to the wishes of your insurance company, is limiting.
OMG... cry me a fucking river. You'd have been a joke back in the 90's taking 30 pills, in three times doses, some with and without food. Now go ahead and have a grand old party with your all-in-one Atripla.
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Generics are fine by me. :)
On the subject of combo vs seperate ingredients:
I was on two of the seperate ingredients to my combo pill separately before switching to the all in one and although the pill counts were higher, adherence wasn't harder. The pills still had the same frequency and restrictions around food. So for me no more or less difficult.