My view on why patients actually choose brand name drugs over generics.

Hello everyone,

Thank you so much for all the positive responses on my previous articles and posts on social media! My engagement is already picking up quite a bit and as I finish my relocation to Miami, FL I promise a lot more content will come regularly! The encouragement has been unreal and has pushed me to get moving full force now!

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Now on to why you clicked on this to begin with.

  • Status or Ability to Pay
  • Recall and a desire for consistency
  • Distrust in Foreign Manufacturing
  • Marketing
  • Fillers

There are a few reasons why patients choose the brand over the generic substitute when they can. Some patients truly just want the brand because of status. I have worked many years in Manhattan with some of the wealthiest in the country. Yes some patients want brand because just because they can afford it. This isn’t limited to Manhattan either.

The past few years we have dealt with a lot of recalls on various medications, but several popular blood pressure medications were the most recent focus: Losartan, Valsartan and Olmesartan. Many generic drug manufacturers have their facilities all over the world, but a big chunk of the Pharma manufacturing is done in India followed by China. These recalls brought on a lot of extra distrust in the sources of medications, and thus a lot of patients started opting for the brand name version of the medication they were already accustomed to taking.

Patients don’t like change when something works, so a recall on the generic ¬†will spark a lot of brand name drug sales. Think about the Epipen fiasco. When Losartan was recalled in 2019 or 2020, it was the first time in years I saw brand Cozaar being approved and used while the generic was impossible to obtain.

One of the other reasons is advertising. We only advertise brand name drugs, and we are one of the few countries who can advertise for pharmaceuticals. When the ads on particular channels that particular demographics watch most, of course that’s the medication they will tell their doctor they need when they have any symptom that matches what the TV just talked about!

Advertising has a lot of issues in itself. Often new drugs that provide little value will get patented and then advertised. The problem here is that most commentators of the industry like to say “just substitute.” I don’t know of a state where you can substitute say; Gabapentin for Gralise. If the doctor writes for one of these new mechanism of action, or even change in strength- the pharmacy cannot just substitute it for the cheapest version of that molecule.

The reasons above account for a small percent overall of why patients choose branded medications though.

The real reason patients don’t want generics is because the generic formulations are not the same at all. Yes they contain the same active ingredient, and we call the other ingredients inactive but they make a difference contrary to what many people say.

Let’s look at the attached chart:

5 Generic versions of Adderall and the brand Adderall’s list of inactive ingredients. We can the generic made by TEVA, whom also makes the brand is identical. The markings and shapes of the pills are different, but that isn’t always the case. It depends on the drug. However the fillers of all the current options available vary quite a bit!

I see:

  1. Silicon Dioxide
  2. Titanium Dioxide
  3. Cellulose Monocystalline
  4. Hypermellose
  5. Magnesium Stearate
  6. Triethyl Citrrate
  7. Stearic Acid
  8. Corn Starch
  9. Talc
  10. Maltodextin
  11. Sucrose
  12. Lactose
  13. Saccharin Sodium
  14. Gelatin
  15. Methacrylic acid
  16. Povidone
  17. Dyes galore….

17 or more possible ingredients and cellulose and hypermellose is the only one in each tablet! Sucrose is known to cause intolerance in the stomach for some, and I have had patients complain that the usually coveted orange footballs made by TEVA upset their stomach. I couldn’t understand why the first time he told me. So I broke down the chart for him and showed it to him. Within seconds he said sucrose! This patient didn’t drink even sugar free red bull because of it. We switched him to a different manufacturer and everything was great by next month.

Maltodextrin side effects may include allergic reactions, weight gain, gas, flatulence, and bloating. Maltodextrin may also cause a rash or skin irritation, asthma, cramping, or difficulty breathing. This may be a bit too much information, but this month my Adderall generic was changed and one side effect of the maltodextrin containing brand I usually use, is a lot less noticeable…






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