Doctors, Insurance Firms Duel On Generics

Patients Caught In The Middle In Push-Pull Battle Over Generics Vs. Name Brand Drugs

(AP) 

After 10 years of taking the cholesterol medicine Lipitor, which has no low-cost generic equivalent, Curran's new insurer under Medicare refused to cover it. They insisted he take the generic equivalent of a completely different drug and he was scared.

"I'm not 25 or 30," he said. "There's something that's working for me with no side effects, why do you want me to experiment?"

His physician, Dr. Mario Motta, gave him free samples of Lipitor provided by drug salesmen. He also wrote to the insurance company to explain Curran had tried generic drugs, but in this case the brand-name drug was essential.

Still the company refused to cover it. Curran started spacing out his medication out of fear he would run out. He wound up in the hospital and had a fifth stent put in to help keep his blood vessels open. The insurance company didn't relent until Motta got the American Medical Association to make a call. Curran was covered by Anthem Blue Cross and Blue Shield, a subsidiary of WellPoint Inc. - the nation's largest insurer based on enrollment.

WellPoint couldn't comment on Curran's specific case because it would violate patient privacy laws, spokeswoman Lori McLaughlin said.

"If a member needs an exception to our formulary benefits, they or their provider have the ability to ask for an exception to our formulary benefits," she said in a written statement. "We also look at prior records we have access to and based upon those we can, in certain circumstances, approve an exception to the formulary benefits. While on average, 75 percent of those patient appeals are approved for coverage, appeals are handled in accordance with guidance from the Centers for Medicare and Medicaid Services."

Insurers say they encourage generics because it keeps consumer costs down when health care expenses are spiking. Companies argue that patients sometimes won't stick to their expensive prescription to try to save money, and a generic alternative could keep their regimen consistent.

"Health plans are not mandating to physicians what to prescribe to patients," said Robert Zirkelbach, a spokesman for America's Health Insurance Plans, a national trade association. "They are providing incentives to encourage greater use of generic drugs."

Drug companies were criticized for encouraging doctors with incentives for years. As a result, the pharmaceutical industry has imposed its own regulations in recent years, allowing only "modest" meals and inexpensive gifts with a medical purpose.

"Insurers paying physicians to switch patients from one treatment to another raises question about whether individual patient needs are being put first," said Ken Johnson, senior vice president of Pharmaceutical Research and Manufacturing of America, in a written statement.

The Rochester dinner for physicians was indefinitely delayed after The Associated Press called with questions. It was organized by a local chamber of commerce, and the stipend was paid for by various businesses, including several insurance companies. It is unclear how often these events occur, because they aren't advertised. Instead invitations are sent directly to doctors.

Most doctors enthusiastically support using generic medication - if it's an exact version of the name-brand drug.

"There are drug classes that you can switch from one drug to another, and there are some that you can't - and the person deciding that should have a medical degree," said Dr. Marc Siegel, an associate professor of medicine at New York University Medicine.

[docpeter1953]

Wouldn''''t you think that after the patent period expires, the original manufacturer could maintain a cost level equal to or less than the generics? Or is it true that they are not "equivalent"?

Posted by drivelphobe at 03:24 PM : Oct 30, 2008
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Try this little experiment for yourself. Go to Wal-Mart, K-Mart, Costco, Walgreen''s CVS, whatever pharmacy you want. Get a bottle of Advil and a bottle of the store brand. Read the labels and open both at home. They are the identical medications. One you pay $10.00 for and the other you pay $7.50 for. they are the same. Ask the pharmists what the difference is and he will tell you none, if he is honest.

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Could someone invent a system of non-synthetic drugs that can be prescribed without influencing the Doctor''''s bank account?

Posted by baileycc at 02:41 AM : Oct 31, 2008
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yes they are already here. They are called naturacueticals. They work, but they take longer to work, and most need to be taken regularly. And, alas, the FDA and the deep pockets of Big Pharma is there at every turn to prevent you from purchasing these.

Now I will agree with them on one point, these naturals have very little control, but shouldn''t the FDA make it mandatory for the producers to ensure that what they are selling meets some standard?

[hennighg]

Oh, well, now I''ve heard enough. Sick people, if they have any patriotism at all, will pay the doctors AND the insurance companies AND the medical companies just as much as they can. What do we need with sick people anyway? If they only gave more money, they wouldn''t be sick, just hungry. But at least they wouldn''t be sick.

Could someone invent a system of non-synthetic drugs that can be prescribed without influencing the Doctor''s bank account?

[drivelphobe]

Wouldn''t you think that after the patent period expires, the original manufacturer could maintain a cost level equal to or less than the generics? Or is it true that they are not "equivalent"?