Buying into generic drugs

Matthew Solan

Executive Editor, Harvard Men's Health Watch

It is amazing how something so small can cost so much. Whether it is a short-term treatment, or multiple drugs you take indefinitely, prescription drugs have the potential to drain your savings.

However, there are many cheaper generic versions of more expensive brand-name drugs. In fact, almost 80% of prescriptions are for generic drugs, according to the Food and Drug Administration (FDA), and on average they cost about 80% to 85% less than brand names. Odds are there is generic version to treat your condition, too, whether it is chronic pain, high cholesterol, high blood pressure, diabetes, asthma, or depression.

But is there a difference between generic and name brand other than price? To better understand this, you have look at how drugs are made, manufactured, and prescribed.

Types of generic drugs

There are two ways generic drugs are used: generic substitution and therapeutic interchange.

Generic substitution means the drug is the equivalent to a brand name on a molecular level. “In terms of effectiveness and quality they are the same, and the FDA has certified both are equal,” says Dr. Niteesh K. Choudhry, assistant professor of medicine at Harvard Medical School. Dr. Choudhry’s research focuses on strategies to improve health care quality and reduce spending. An example is the cholesterol drug Lipitor and the generic version atorvastatin.

Therapeutic interchange is slightly different. The generic is a medical substitute that is molecular related, but not exactly the same. “It is like the difference between a Coke and a store brand cola,” says Dr. Choudhry. Therapeutic interchange is often used for name brands that do not yet have a generic substitution because the brand name patent still exists.

Are therapeutic interchange drugs just as effective as brand names? For the most part, yes, says Dr. Choudhry. “It depends on the drug, what it is designed to treat, and the person, but it often is equally effective. Of course, the downside is they are not 100% guaranteed to work.”

However, most research tends to support the effectiveness of both types of generic drugs. A 2015 report published in the Jan. 5, 2016 issue of the Annals of Internal Medicine advocated the greater use of generic drugs, citing research that supports its overall equality with brand-name counterparts as well as its valuable cost-savings.

Consult with your doctor

Do not assume your doctor will always offer you the choice of a generic drug. A 2016 ProPublica analysis found that doctors who receive payments from the medical industry tend to prescribe more brand-name drugs, on average, than those who do not. The report does not prove that industry payments sway doctors to prescribe specific drugs, or even a particular company’s drugs, but it does show payments are associated with that trend.

Even if doctors are not part of this arrangement, they may prescribe brand names based on their medical preference and past success with patients, says Dr. Choudhry. “Also, doctors may not know a generic version of a therapeutic interchange has become available since it is unusual for generics to be officially announced,” he says.

Dr. Choudhry suggests that people be proactive when prescribed any medication and always inquire if there are generic versions available. Another option: in many states pharmacies can switch to a generic substitution — but not a therapeutic interchange — as long as there is no “dispense as written” requirement from your doctor.

Remember that most drugs, whether brand name or generic, do not work the same for everyone. Yet, if a generic drug is not successful, you are not forced to switch to the brand name. “Some drugs have multiple generic versions,” says Dr. Choudhry. “So often you have more options from which to choose.”

Related Information: Harvard Men’s Health Watch


  1. pihu jain

    thanks for the knowledgeable article !!!! I completely agree to this
    why we waste so much of our money on branded drugs when their generic counterparts are available at a very low cost and they are as effective as branded ones. I come to know about both these drugs from a site mediklik which provide detailed information about these drugs and a lot more you should check it once

  2. A Wilson

    Name brand and generic drugs have both advanced throughout the years. When one drug hits the market, often times many other generics follow behind it. The hard part is deciphering which one will actually work for you. The benefit of generic drugs is if you do not have insurance, you wont have to pay five to eight hundred or more dollars to treat your ailment. If you do have insurance though, you will only have to pay five to fifteen dollars for prescriptions or they may even be fully covered. The issue at hand is when do these drugs become addictive? Do they start to work so well or make the patient feel so much better that when the duration of the prescription is over, the drugs are a necessity? When people start feeling the need for drugs, name brand or generic, they should always seek assistance although this does not happen most of the time. Harbor Village Detox is a great place for counseling or addiction help. If someone were to become addicted to their prescribed name brand or generic drug, acquiring guidance is a next step option.

  3. Roz

    Personally, I prefer taking brand for Thyroid meds. The meds I get from mom & pop pharmacies from India always work different then Walgreens etc. I like supporting business in my town but can not if it affects how I feel. After I have meds filled at the Mom & Pops and notice a difference I google & find people furious that they are different.

  4. Mary northern

    Why does a pharmacy have the right to change your med. from one generic to another, without telling you. I don’t like that because when I have one working good for me I want to stay on it. Some generics do not work for me. Walmart is bad for doing this.

    • Judy Neal

      I have had a major reaction to some drugs manufactured in India. We figured it was not the drug itself, but the “filler” they use which may contain some form of shellfish… which I am highly allergic!
      I have an awful time trying to convince pharmacies that I cannot take certain brands of generic drugs but just about the time I get this through their heads, “corporate” changes their supply to a cheaper brand. It is a day-to-day battle!!!

  5. Nancy Lorance

    The Supreme Court ruled in 2011 that generic drug makers cannot be sued under state law for adverse reactions to their products, a decision that consumer advocates say is a patient safety problem. People can easily look up on-line the ‘authorized version’ of a brand name drug, if generics are available. The ‘authorized version’ is the EXACT formulations of the brand name drug. DO NOT confuse ‘authorized version’ as just ANY generic of a brand name drug, it is not. Then take this information and ask pharmacies in your area if they sell the manufacturer’s named ‘authorized version’ of the brand name you are wanting. NOTE: many pharmacists will act as though any generic drug is an authorized version so KNOW the EXACT name of the manufacturer of the ‘authorized generic’ that you are wanting.

  6. Fred J. Pane

    Dr. Choudhry, thanks for covering this topic because I believe people are still afraid of generics in some cases and with the advent of biosimilars, we have come to another bridge. As a hospital based pharmacist for over 23 years, we used generics all the time if approved by the FDA in The Orange Book as AB rated. Most patients don’t know that there are criteria for approval of Generically Substitutable Drugs. We also did Therapeutic Substitutions for classes of drugs as yuo reference: One Proton Pump for another if Same efficacy, side effect profile, and could save monety. The models adopted by hospitals over the years, was the foundation of how the PBMs and Health Plans set up their prescription plans and co-pays. Health plans explain their prescription model in a handbook given to their patients/beneficiaries, but I don’t feel that their is enough follow up with patients and prescribing physicians.

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