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A question about Healthcare in the US, please

A question about Healthcare in the US, please

Old Dec 25th 2014, 3:25 am
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Default Re: A question about Healthcare in the US, please

Originally Posted by Pulaski
I understand your frustration, but when doctors insist on prescribing branded drugs when there are generics available, one of the drivers of medical costs is the huge price differential between the branded and generic drugs, and I for one am glad that someone is keeping an eye on the cost of prescribing branded drugs when there are generics available.

To be totally clear, I have no issue with people in Augigi's situation where there is no generic equivalent and she needs the branded drug, but others shouldn't be allowed to inflate the cost of medical insurance by having insurance pay unnecessarily for branded drugs.
Nothing to do with drugs. In this case it was a local eye doctor they already approved me for, but denied my daughter. Same plan, same doctor. Instead they want to send her to one 60 miles away who is more expensive and has no experience in our relatively rare eye conditions.
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Old Dec 25th 2014, 3:29 am
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Default Re: A question about Healthcare in the US, please

Originally Posted by Michael
I'm not confusing it. Lipitor was on patent until about a year ago and therefore only a brand name drug was available and that is what I am talking about. It is pure stupidity for a doctor to prescribe a brand name drug or a patient to demand a brand name drug when a generic is available such as Zocor which has been off patent for many years instead of the generic Simvastatin. You probably noticed that Lipitor has not been advertised for over a year.

I don't think that a doctor prescribing a brand name drug or a patient demanding a brand name drug when a generic is available is a big problem since an insurance company can say no since a patient or doctor can't prove that the brand name drug is better of different than the generic.

At the VA hospital they always start with generic drugs first and don't carry brand name drugs that have a generic equivalent and only then will they prescribe brand name drugs that don't have a generic equivalent.
I don't understand what you mean by "Sometimes brand drugs aren't as effective as generic drugs ..... " then? It's either a pharmaceutically-identical generic, or it isn't (a generic at all). It sounds as if you were comparing similar (non-identical), drugs.
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Old Dec 25th 2014, 3:41 am
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Default Re: A question about Healthcare in the US, please

Originally Posted by Pulaski
I don't understand what you mean by "Sometimes brand drugs aren't as effective as generic drugs ..... " then? It's either a pharmaceutically-identical generic, or it isn't (a generic at all). It sounds as if you were comparing similar (non-identical), drugs.
I'm talking about the same type of drugs. For instance, a new Beta Blocker could be approved with a 20 year patent that may not be as effective as the generic Beta Blocker Metoprolol Succinate but will still be approved by the FDA. They are both Beta Blockers but with different chemical compounds.

As long as the drug doesn't do more harm than the generic drug of the same type and the drug manufacturer can prove the drug to be somewhat effective, it is usually approved by the FDA. The most common occurrence of this happening is with serotonin antidepressants since none are very effective. Therefore there are at least 30 serotonin antidepressants on the market and new ones introduced each year and none seem to work very well.

Last edited by Michael; Dec 25th 2014 at 4:04 am.
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Old Dec 25th 2014, 3:57 am
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Default Re: A question about Healthcare in the US, please

Originally Posted by Michael
I'm talking about the same type of drugs. For instance, a new Beta Blocker could be approved with a 20 year patent that may not be as effective as the generic Beta Blocker Metoprolol Succinate but will still be approved by the FDA. They are both Beta Blockers but with different chemical compounds.

As long as the drug doesn't do more harm than the generic drug of the same type and the drug manufacturer can prove the drug to be somewhat effective, it is usually approved by the FDA. The most common occurrence of this happening is with serotonin antidepressants since non are very effective. Therefore there are at least 30 serotonin antidepressants on the market and new ones introduced each year and none seem to work very well.
OK, so as I first said, paraphrasing, you wrote one hybrid post talking in part about "generics" (pharmaceutically-identical drugs), and partly about similar non-identical drugs (I previously said you had "confused" the two). The two are quite separate issues, though both have large cost implications.

Similar to what you said about VA hospitals, NHS hospital pharmacies in the UK are able to freely substitute any generic drug if the doctor prescribes a brand name drug. They obviously cannot do the same with "similar" drugs. "High street" (retail) pharmacies in the UK have to dispense the drug exactly as described on the prescription, so not only do they have to stock high(er) cost drugs but they have to stock two or more versions of many drugs.

Last edited by Pulaski; Dec 25th 2014 at 4:17 am.
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Old Dec 25th 2014, 4:09 am
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Default Re: A question about Healthcare in the US, please

Originally Posted by GeoffM
Nothing to do with drugs. In this case it was a local eye doctor they already approved me for, but denied my daughter. Same plan, same doctor. Instead they want to send her to one 60 miles away who is more expensive and has no experience in our relatively rare eye conditions.
Yeah, well I agree, that's daft. I have no particular concerns about medically valid decisions, but prescribing high cost drugs/ treatments is, IMO quite rightly, being clamped down on, when there are low(er) cost alternatives that are either generics, or similar low-cost drugs that have a similar likelihood of being effective.
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Old Dec 25th 2014, 4:15 am
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Default Re: A question about Healthcare in the US, please

Originally Posted by Pulaski
OK, so as I first said, paraphrasing, you wrote one hybrid post talking in part about "generics" (pharmaceutically-identical drugs), and partly about similar non-identical drugs (I previously said you had "confused" the two). The two are quite separate issues, though both have large cost implications.
I agree that maybe I cause some confusion since over the counter drugs are always on the shelves as brand name and generic and some people tend to pay the high price of the brand name drug but in those cases, the cost is still fairly reasonable for a 30 day supply. However for prescription drugs, a person normally isn't going to demand a brand name drug that costs over $100 when they can get the same drug but generic for a few dollars.
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Old Dec 25th 2014, 4:22 am
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Default Re: A question about Healthcare in the US, please

Originally Posted by Michael
I agree that maybe I cause some confusion since over the counter drugs are always on the shelves as brand name and generic and some people tend to pay the high price of the brand name drug but in those cases, the cost is still fairly reasonable for a 30 day supply. However for prescription drugs, a person normally isn't going to demand a brand name drug that costs over $100 when they can get the same drug but generic for a few dollars.
Many people in both the UK and the US seem to treat their doctors as infallible gods, and won't question their doctor's advice, including the drugs prescribed. Who knows why a doctor might prescribe the brand drug instead of the generic, but I bet some do, and I doubt many people would notice, much less question the decision.
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Old Dec 25th 2014, 6:53 am
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Default Re: A question about Healthcare in the US, please

Originally Posted by Pulaski
Many people in both the UK and the US seem to treat their doctors as infallible gods, and won't question their doctor's advice, including the drugs prescribed. Who knows why a doctor might prescribe the brand drug instead of the generic, but I bet some do, and I doubt many people would notice, much less question the decision.
Some doctors don't know or remember the generic name but all the pharmacies that I've been to in the 1990s ask if it is ok to fill the prescription with the generic drug. I'm sure there are a few small pharmacies that will just fill the prescription as the doctor prescribes without questioning and then the person says wow, $90 copay.
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Old Dec 25th 2014, 7:15 am
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Default Re: A question about Healthcare in the US, please

I have a friend that started getting severe depressions when he was in his late 50s and was hospitalized when his physician/psychiatrist couldn't figure out how to stabilize him. Eventually he was prescribed a cocktail of 3 serotonin drugs and he was ok. However about every 5 years, he relapses and is back in the hospital and a new cocktail is found. I suspect pharmaceuticals discovered this is a good way to make money by changing the compound slightly instead of spending the money to figure out what will really work.

Personally I think they are on the wrong track with serotonin drugs.

If fact studies have shown that serotonin drugs are no more effective than placebos for most people but researchers don't want to stop prescribing serotonin drugs since if a person feels better, that is the important thing. However if the depressions are severe, the serotonin drugs seem to help.

But a report recently published in The Journal of the American Medical Association showed that the drugs work best for very severe cases of depression and have little or no benefit over placebo (inactive pills) in less serious cases.

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Old Dec 25th 2014, 7:43 am
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Default Re: A question about Healthcare in the US, please

Originally Posted by Pulaski
Yeah, well I agree, that's daft. I have no particular concerns about medically valid decisions, but prescribing high cost drugs/ treatments is, IMO quite rightly, being clamped down on, when there are low(er) cost alternatives that are either generics, or similar low-cost drugs that have a similar likelihood of being effective.
Well yes, but that's not what I was talking about! It was you that started on about generics and suchlike which had me scratching my head somewhat. My earlier post was about two generics, one ten times the price of the other (ish) and since the cheaper one worked just as well, I had absolutely no objections to switching. Different drugs entirely, mind.

I don't get the mentality of buying stuff like Advil when the active ingredient is Ibuprofen which you can buy a hundred of for the same price as a strip of Advil.

Originally Posted by Michael
Personally I think they are on the wrong track with serotonin drugs.
Do you mean SSRIs? If so, I would tend to agree from the few that I was experimented on with (erm... didn't quite make sense). The side effects were far worse than the supposed benefits - and missing a dose by just a couple of hours was one of the worst feelings I've ever had.


Changing the subject slightly, with Kaiser the nurse you always saw before the doctor always asked what drugs I was on. She would read a name I'd never heard before, which wasn't on her screen, not on any medicine or eye drop bottles, and would often turn out to be some brand name. Why do that? Why not ask what's on the screen which is also what's on my prescription, and which is also what is dispensed?! Not just one nurse - all of them! Aaargh!
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Old Dec 25th 2014, 8:20 am
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Default Re: A question about Healthcare in the US, please

Originally Posted by GeoffM
Do you mean SSRIs? If so, I would tend to agree from the few that I was experimented on with (erm... didn't quite make sense). The side effects were far worse than the supposed benefits - and missing a dose by just a couple of hours was one of the worst feelings I've ever had.
Yup and once Prozac came on the market, everyone followed suit. Then as each of the older drugs went off patent, more new serotonin drugs came on the market.

Personally I think the very old antidepressants work better especially for younger people such as the Tricyclic antidepressants (Amitriptyline or Elival) but doctor seldom prescribe them anymore except for sleep (not addictive like the newer sleep drugs like Ambien, can take them forever, and often works better). In fact there have been studies that Tricyclic antidepressants are better than placebos.

Although as an antidepressant, it is supposed to be taken 3 times per day but it works for some people just before bedtime at a very low dosage (5-10 mg) and it is dirt cheap.

I suspect why Tricyclic antidepressants seem to work for some people is that it can possibly turn off a spinning brain when going to sleep and a person can wake up refreshed. The most common side effect is dry mouth and depending on your metabolism, it can possibly cause tiredness. Some people in the 1970s had good luck with them.

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Old Dec 25th 2014, 12:31 pm
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Default Re: A question about Healthcare in the US, please

Originally Posted by GeoffM
I don't get the mentality of buying stuff like Advil when the active ingredient is Ibuprofen which you can buy a hundred of for the same price as a strip of Advil.
This is crazy, it seems incredibly prevalent in the US. I suspect it is to do with TV advertising, an added cost of marketing and product placement which is why the brand name product is so expensive. I don't have TV, so the brand names mean nothing to me. In conversation, I always refer to ibuprofen or acetaminophen (for instance) but many people only seem to know the expensive brand names. Further, the drug store places expensive brand name aspirin beside their own label version which is much cheaper. But the brand name aspirin gets better shelf placement, which they presumably pay for...

Not just drugs, it's as if people lose all sense of value for money in the drug store. I buy Pepsodent toothpaste at 99c a tube, the brand name ones are in the $2.50 to $5 range. My acquaintances who buy this expensive brand name stuff are the ones who tell me they will never be able to afford to retire.
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Old Dec 25th 2014, 12:43 pm
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Default Re: A question about Healthcare in the US, please

Originally Posted by robin1234
This is crazy, it seems incredibly prevalent in the US. I suspect it is to do with TV advertising, an added cost of marketing and product placement which is why the brand name product is so expensive. I don't have TV, so the brand names mean nothing to me. In conversation, I always refer to ibuprofen or acetaminophen (for instance) but many people only seem to know the expensive brand names. Further, the drug store places expensive brand name aspirin beside their own label version which is much cheaper. But the brand name aspirin gets better shelf placement, which they presumably pay for...

Not just drugs, it's as if people lose all sense of value for money in the drug store. I buy Pepsodent toothpaste at 99c a tube, the brand name ones are in the $2.50 to $5 range. My acquaintances who buy this expensive brand name stuff are the ones who tell me they will never be able to afford to retire.
I can and do find Ibuprofen on the shelf with little to no effort, and yes it is cheaper than P&G stuff. I have a hard time caring why others buy the more commercial stuff. And yes P&G along with Kellog etc... pay Kroger etc. for premium shelf space. Premium meaning of course eye level, not down around your ankles.
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Old Dec 25th 2014, 1:02 pm
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Default Re: A question about Healthcare in the US, please

Originally Posted by robin1234
This is crazy, it seems incredibly prevalent in the US. I suspect it is to do with TV advertising, an added cost of marketing and product placement which is why the brand name product is so expensive. I don't have TV, so the brand names mean nothing to me. In conversation, I always refer to ibuprofen or acetaminophen (for instance) but many people only seem to know the expensive brand names. Further, the drug store places expensive brand name aspirin beside their own label version which is much cheaper. But the brand name aspirin gets better shelf placement, which they presumably pay for...

Not just drugs, it's as if people lose all sense of value for money in the drug store. I buy Pepsodent toothpaste at 99c a tube, the brand name ones are in the $2.50 to $5 range. My acquaintances who buy this expensive brand name stuff are the ones who tell me they will never be able to afford to retire.
I agree with all of this. It's effing nuts! ..... Though at least part of the problem is that people use the brand name to refer to the the generic drug. Mrs P refers to our supply of generic ibuprofen as "Advil", or sometimes as "Motrin"!
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Old Dec 25th 2014, 6:51 pm
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Default Re: A question about Healthcare in the US, please

I'd never even heard of Motrin until I came here - though I understand you could get it in the UK too.
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