By Steve Wilson (WXYZ) -- They’re promoted as perhaps the very best way to reduce the soaring cost of medical care these days but Action News Investigators have questions tonight, are they as universally good as we’ve been told?
Telling you what you probably haven’t heard about generic drugs from your druggist or even your doctor, and let’s say it right upfront: Yes, for most of us most of the time, they’re safe, they’re effective, and these copycat capsules and tablets do cost only a fraction of the brand name drugs you see advertised. So, what are we *NOT* being told? Let’s start with how your pharmacy is likely giving you a generic whether you knew it or not, and whether you wanted it or not.
Ilise Haldeman/Epilepsy Patient: They just gave me the generic… they just looked at the financial end of it and made the assumption that I was willing to put my life at risk rather than pay the difference.
We’re talking about Keppra, a drug prescribed two years ago by Ilise Haldeman’s doctor to prevent epileptic seizures.
Wilson: And it’s done its job in the last two years?
Haldeman: Umm-hmm.
But when her usual mail-order pharmacy sent her re-fill the other day, they didn’t send Kepra. On their own, they sent a newly available generic instead. She called her doctor who called her local CVS store with another prescription for the Kepra he thinks best in her case. But again at CVS, she was not getting what the doctor ordered.
Haldeman: No, they just said the generic had come out and that’s what they were refilling with.
CVS says it initially overlooked the doctor’s specific instruction, but did you know
—secret #1—that at CVS, Walgreen’s, Rite Aid, Costco and at others we checked, unless your doctor has written in this box the letters DAW—dispense as written—the policy is to fill it with a generic, and there’s no law that you even have to be told of the switch.
A CVS spokesman told me they do it under pressure from health plans and employers “to save money.” In the case of Keppra, the generic costs a third less, a significant savings of about $12 a day. So, why is a “secret switch to save money” such a big deal to Ilise, her doctor, and others? Kelly Van Singel knows.
Kelly Van Singel/Jay’s Sister: They said no, no, no, this is just the generic form of Dilantin. Go ahead, they’re fine, take ‘em.
But not long after Kelly’s 30-year-old brother did, he was dead. On the brand-name drug Dilantin, seizures had stopped. Within 48 hours of taking the generic, it was a seizure that killed him.
Dr. Brien Smith/Neurologist: A number of things can lower seizure threshold. At least the history provided by his family was none of those things were present and the only thing that occurred a couple of days earlier was the generic change. Thing is, is there a scientific way that we can prove it?
As we said, primarily to save money which certainly is a necessity these days when healthcare costs are out of control, health plans like Blue Cross want your doctor to put you on these cheaper generics as often as possible.
Andrew Hetzel, V.P./Blue Cross/Blue Shield MI: These generic drugs are FDA approved, they are regulated, they are proven safe and effective, they are exact copies of the brand name alternatives which are significantly more expensive.
Hold on, here’s secret #2. Despite what we hear all the time, generics are not “exact copies” of brand name drugs. The generic version of Ilise’s Keppra: yes, says Dr. Smith, it contains the same active key ingredient…
Dr. Smith: So you would think ‘I’ve got the same amount of active drug here and active drug here, there shouldn’t be a difference,’ but there is a difference because the fillers and other ingredients that are put in that are considered inactive ingredients can be different.
And the difference in those fillers can affect, for instance, how the needed active ingredient is absorbed in the body—too quickly? Not fast enough? In surveys, a whopping two-thirds of neurologists report they have cared for a patient who had a seizure or toxic side effect they associated with a switch to a generic. Here in Detroit, Dr. Smith says he’s seen problems related to generics in 5 to 10% of his epileptic patients, and most worrisome: studies relied upon as proof that every generic is safe are conflicting and have never included epileptics or others who seem to be at greater risk than most of us using generics with no problem.
Dr. Smith: Unfortunately, sometimes these problems are viewed as collateral damage, where it’s a small population and we’ll deal with it and move on from there.
And secret #3 you likely never knew? With billions and billions that can be saved every year using generics, your doctor may well be pocketing his or her share of millions in cash to switch you and your family to generic drugs and meet other cost-cutting benchmarks. Blue Cross calls them “incentive rewards for meeting efficiency standards.”
Wilson: How much is the overall reward?
Hetzel: I’m not really going to get into specifics over that…It’s a competitive issue. I’m sure our competitors in the marketplace would love to know details of our collaborative programs and how they’re structured.
Make no mistake, you, your employer, taxpayers all of us have a stake in getting health care costs down and I should say in fairness that while Blue Cross is the biggest here in Michigan, the other healthcare providers are doing this, too—quietly paying doctors bonus cash to get them to meet certain benchmarks like prescribing generics most of the time to save money…but I’ll be back here tomorrow on Action News at 5 to show you the risk is not limited only to epileptics, the examples you saw tonight.
And finally: In a few other states, it’s illegal for your pharmacy to switch you to generics without your knowledge… such a bill is pending in Lansing.
To learn more about epilepsy and ways to treat it, visit www.epilepsyfoundation.org or www.epilepsy.com
