While it is true that we often will purchase generic over name brands, this is mostly a cost issue. It’s not unreasonable to start with a less expensive medication that is close to the name brand and see if it performs up to par before considering a switch
Marketing drives much patient perception on medications to the extent that some patients will come in requesting specific medications. I find myself explaining a bit more why some of these medications may not be ideal for their specific condition
There are some drugs worth paying more for. The bottom line is that brands and generic medications are not the same. Generic medications may have the same active ingredients but there are differences in effectiveness and absorption. The FDA acknowledges that generic medications are not aware of the precise ‘recipe’ for brand name medications. They have to reverse engineer these medications. They only require that the generic medications concentration of active ingredient not fall below 20% if the name brand or 25% higher. There are and can be differences in the absorption as well.
Practically speaking, the biggest issue for me as a practitioner comes when a pharmacy switches between two generic version of the same medication for a patient. Say one month the patient receives Claravis and the next they receive Myorisan (both are generics of Accutane, known as isotretinoin). Think about this- if one of those generic’s active ingredient, isotretinoin, is as low as 20% below the brand name’s concentration and the other is 25 % higher- there can be a 45% increase or decrease in effectiveness immediately. This is a problem. For this reason, again practically speaking, it’s often cost inhibitive to do anything about this. We at least attempt to ask the pharmacy to at the very least try to keep the generic version the same to avoid these fluctuations.
There are two specific medications that simply have less effectiveness in their generic form in my experience- Neoral (cyclosporine) and Synthroid.
Some will swear that the name brand works better for them than the generic- this is not necessarily a placebo effect. It’s simply that the name brand has tested its claims against its product. Generic medications claims are based on an assumption that it will perform the same. If you take the accutane example again, when there was no generic I could precisely say that patients will be on it for 20 weeks. With genetrcs I have to follow patients and keep them on the medication until they clinically clear which can vary widely.
Problem is that it’s becoming cost inhibitive to provide care. We are generally not talking about a $4-$5 price difference- it’s often hundreds of dollars to consider.