I am not a physician, rather was a Clinical Assistant to several psysicians throughout my four decades of being a part of the health care profession.
I agree with the majority of your article. However, I would like to make note of a couple of things that were not mentioned when speaking of Branded medications.
My experience, working in the medical field prove two very notable things. First and foremost, all generics are NOT EQUAL as the “fillers” used vary from Brand as well as among companies. I personally witnessed the decline of the majority of our decades long stable patient population when two of our daily medications went generic. Both of these medications took months and in some patients, years, to reach therapeutic dose. As I said they were established stable patients. Both medications required slow titration to discontinue. One of the medications required increased dose to achieve the therapeutic effect of Brand. This is CLINICAL WITNESSED FACT. The decline did not occur overnight, rather, 3-6mos before we recognized the pattern. All had been switch to generic.
The second, and I feel unbelievably egregious, is that while all of our hard working paying patients were forced onto generic medications; our patients on MEDICAID were allowed FIVE(5) Brand medications, paid for with those patients, and all working class persons tax dollars.
I have been out of the medical field for almost a decade & can only hope that there have been positive changes but admittedly doubt much has.
Thank you for taking the time to read and comment on my article. Yes I am a physician but that hardly makes me infallible; I don’t know everything and certainly make mistakes like everyone else. Your experience as a clinical assistant is no less valuable than mine as a physician.
On your point regarding the variability of inert ingredients between different generics, you are 100% correct. Likewise, your point regarding some patients not responding well to certain generic formulas is well known; I did have similar experiences with some patients over the years. For those patients with documented problems writing “Brand Name Necessary” in the prescription is the correct thing to do, and they are NOT the ones I am talking about here.
The patient I allude to here is the one that always request brand name medication for NO medical reason, then demands the brand name necessary phrase on the prescription to force the insurance company pay the difference for their personal preference. I did have several of those patients through the years.
“The second, and I feel unbelievably egregious, is that while all of our hard working paying patients were forced onto generic medications; our patients on MEDICAID were allowed FIVE(5) Brand medications, paid for with those patients, and all working class persons tax dollars.”, you are once again correct, though I’m not sure that is the case anymore since my last years of practice were exclusively in the hospital setting.
“I have been out of the medical field for almost a decade & can only hope that there have been positive changes but admittedly doubt much has.”, unfortunately you are once again correct, some recent changes were good, many others not so much.
I really appreciate you reading my work and leaving such a thoughtful comment.
Bren I want to thank you for pushing back on my original comment. I have to admit my lack of knowledge of how the Medicaid program actually works in this area and your comment made me look deeper into how the program actually works.
The Medicaid program provides broad prescription drug coverage, including brand-name drugs, with minimal out-of-pocket cost to enrollees. Federal law requires that pharmaceutical manufacturers pay rebates (that normally go to the prescription benefit management company) to Medicaid on all covered drugs, which means Medicaid actually negotiates significant price reductions from manufacturers as a condition of participation. The program is not simply paying full retail prices for brand-name drugs out of taxpayer funds, not even close.
The five brand-name drugs allowance reflects a state-specific policy that implemented or considered limits on the number of brand-name drugs that any Medicaid patient may receive per month. This was a cost-control measure, not a benefit expansion. Most states require the use of generics when available, unless the prescribing doctor documents medical need for a brand-name drug. Medicaid has consistently favored generics as strongly as commercial insurance, or more.
Medicare Part D is a private insurance program (not a part of federal Medicare program as currently designed) that enrollees pay premiums for, with formularies managed by private plan sponsors. As such, it operates under the rules of the private insurance market not the federal government.
So the truth is not what we initially suspected. The reality is that Medicaid participants get similar benefits as the rest of us: they are required to use generics and allowed brand name drugs where medically necessary. In fact, Medicaid beneficiaries actually have a limit on the maximum number of brand name drugs they are allowed per month, a limit the rest of us don’t have.
So now that I have actually done my research, I have to say I was wrong in my original agreement. Hopefully this will serve to clarify the issue for everyone.
I am not a physician, rather was a Clinical Assistant to several psysicians throughout my four decades of being a part of the health care profession.
I agree with the majority of your article. However, I would like to make note of a couple of things that were not mentioned when speaking of Branded medications.
My experience, working in the medical field prove two very notable things. First and foremost, all generics are NOT EQUAL as the “fillers” used vary from Brand as well as among companies. I personally witnessed the decline of the majority of our decades long stable patient population when two of our daily medications went generic. Both of these medications took months and in some patients, years, to reach therapeutic dose. As I said they were established stable patients. Both medications required slow titration to discontinue. One of the medications required increased dose to achieve the therapeutic effect of Brand. This is CLINICAL WITNESSED FACT. The decline did not occur overnight, rather, 3-6mos before we recognized the pattern. All had been switch to generic.
The second, and I feel unbelievably egregious, is that while all of our hard working paying patients were forced onto generic medications; our patients on MEDICAID were allowed FIVE(5) Brand medications, paid for with those patients, and all working class persons tax dollars.
I have been out of the medical field for almost a decade & can only hope that there have been positive changes but admittedly doubt much has.
Hi Leigh.
Thank you for taking the time to read and comment on my article. Yes I am a physician but that hardly makes me infallible; I don’t know everything and certainly make mistakes like everyone else. Your experience as a clinical assistant is no less valuable than mine as a physician.
On your point regarding the variability of inert ingredients between different generics, you are 100% correct. Likewise, your point regarding some patients not responding well to certain generic formulas is well known; I did have similar experiences with some patients over the years. For those patients with documented problems writing “Brand Name Necessary” in the prescription is the correct thing to do, and they are NOT the ones I am talking about here.
The patient I allude to here is the one that always request brand name medication for NO medical reason, then demands the brand name necessary phrase on the prescription to force the insurance company pay the difference for their personal preference. I did have several of those patients through the years.
“The second, and I feel unbelievably egregious, is that while all of our hard working paying patients were forced onto generic medications; our patients on MEDICAID were allowed FIVE(5) Brand medications, paid for with those patients, and all working class persons tax dollars.”, you are once again correct, though I’m not sure that is the case anymore since my last years of practice were exclusively in the hospital setting.
“I have been out of the medical field for almost a decade & can only hope that there have been positive changes but admittedly doubt much has.”, unfortunately you are once again correct, some recent changes were good, many others not so much.
I really appreciate you reading my work and leaving such a thoughtful comment.
Are you both saying Medicaid patients don’t deserve brand name care? Or that it should be equitable with Medicare? Hopefully the latter.
Bren I want to thank you for pushing back on my original comment. I have to admit my lack of knowledge of how the Medicaid program actually works in this area and your comment made me look deeper into how the program actually works.
The Medicaid program provides broad prescription drug coverage, including brand-name drugs, with minimal out-of-pocket cost to enrollees. Federal law requires that pharmaceutical manufacturers pay rebates (that normally go to the prescription benefit management company) to Medicaid on all covered drugs, which means Medicaid actually negotiates significant price reductions from manufacturers as a condition of participation. The program is not simply paying full retail prices for brand-name drugs out of taxpayer funds, not even close.
The five brand-name drugs allowance reflects a state-specific policy that implemented or considered limits on the number of brand-name drugs that any Medicaid patient may receive per month. This was a cost-control measure, not a benefit expansion. Most states require the use of generics when available, unless the prescribing doctor documents medical need for a brand-name drug. Medicaid has consistently favored generics as strongly as commercial insurance, or more.
Medicare Part D is a private insurance program (not a part of federal Medicare program as currently designed) that enrollees pay premiums for, with formularies managed by private plan sponsors. As such, it operates under the rules of the private insurance market not the federal government.
So the truth is not what we initially suspected. The reality is that Medicaid participants get similar benefits as the rest of us: they are required to use generics and allowed brand name drugs where medically necessary. In fact, Medicaid beneficiaries actually have a limit on the maximum number of brand name drugs they are allowed per month, a limit the rest of us don’t have.
So now that I have actually done my research, I have to say I was wrong in my original agreement. Hopefully this will serve to clarify the issue for everyone.
My position is that everyone needs to be treated equally.