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After months of targeting drug makers over their pricing, Senator Chuck Grassley is now probing one of the biggest insurers in the mid-Atlantic region, opening what may become another front in the battle over the cost of prescription medicines.

The lawmaker has asked CareFirst BlueCross BlueShield to explain a complicated policy that he suspects may force patients to overpay for brand-name medications that doctors have specified must be dispensed. Grassley is also concerned that some people may instead feel they have no choice but to opt for lower-cost generic drugs that, in such situations, may not be as effective.

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  • Might I remind the respondent rlux that as a pharmacist for decades, the concepts of chemical entities, generic drugs, proprietary drugs, bioequivalence, pharmcodynamics, and pharmacokinetics are subjects studied in the doctoral curriculum for years, as well as updated regularly. It is not a matter up for political debate, but has firm scientific research behind it.

  • One final point I neglected to include – if generic drugs are as safe and effective as branded drugs in virtually all cases, then why did the Federal regulations(Department of Labor) and Medicare/Medicaid regs include the requirement that if patients’ doctors prescribe brand name medications, as opposed to generic formulations, as “medically necessary”(by writing “dispense as written” or the like on a prescription, health insurances companies must waive any “brand penalty” on those prescriptions, unless they can demonstrate proof the doctor’s designation was unwarranted.
    Obviously Congress and the Federal agencies involved concluded doctors, rather than pharmacists and health insurers, should dictate what is best for their patients.

  • There is no point is responding to Mr. Nakajima. He obviously has not studied the issue – I spent over a year doing so, including FDA explanations for why it was compelled to pull generic versions of Wellbutrin off the market – and well as multiple court decisions addressed to issues patients have with generic drugs, and brand penalties. I would advise, too, you not set up “Straw men”, such as writing that I wrote “most generic medications have not been shown to be scientifically shown to be equally effective” – review my response and point to the sentence where I said “most”. You can’t. As a pharmacist, you obviously know there is a difference between how constituent elements of medications are delivered into the bloodstream and circulated’ how generics can have constituents elements withinb a fix ed percentage – I believe 20% of brand drugs; how generic manufacturers do not conduct the extensive tests on human beings that brand manufacturers do; how PBM’s often make more money selling generic drugs than brand name drugs – meaning it is in their interest to promote the benefits of generics; And are you suggesting FDA public notices that appear on Google are false, because they are retrievable on Google/ if you are, them what is the best way for consumers to find out if generic drugs are effective or not? And how many doctors, especially endocrinoligists are you aware of who prescribed generic synthroid instead of the brand. product. Or as an expert, are you saying they’re wrong, and you’re right, and know more about branded v. generic products than doctors who prescribe them on a regular basis. While you’re at it, why don’t you research the number of patients reporting adverse effects from the newly-released generic form of Crestor; My doctor has reported to me 3 patients he had to switch back to the brand because of the adverse side effects.
    Clearly, your mind was made up on this years, if not decades ago – and your views, however misguided, are may not be challenged.

  • hlux… If you’re so convinced that most generic medications have not been scientifically shown to be equally effective as the original brand name product, then there’s nothing I can say that will improve your​ ability to think about this matter. After all, if we as practitioners can depend on the 30 percent of us that will ‘get better’ on a placebo (for pain control), then what’s to say we can’t get better on a generic compared to a brand name product? I can say this seemingly rude and insulting statement to you for two basic reasons in response to your argument. 1. You cite as your point of reference Google, which is basically meaningless, the catch as catch can of Enquirer-type fiction, and 2. examples you give aren’t really generally measurable in terms of efficacy. Effective levels of thyroid hormones are in a larger range than you expect and there are variables to consider in establishing a proper dose including drug interactions, activity levels, other concomitant medical conditions such as euglycemia, circadian rhythms. Nevertheless, consideration of all those factors doesn’t address drugs manufactured with narrow therapeutic windows. And, there’s just a few, that would give me pause to consider brand name only, but not many drugs used in treatment of psychological conditions. The problem with Wellbutrin was that the brand name company came up with two different indications, related, but different– depression AND smoking cessation, and at first there was an issue with PBMs not approving coverage for smoking cessation, then there’s the issues of 3 forms of Wellbutrin-once daily XL, twice daily SR, and a third, not either, and the improper prescription of SR only one time a day, if the patient really needed to take it twice daily. At one time, we pharmacists could fill prescriptions based on 3 P preference factors of consideration- physician, pharmacist, and patient. Now, it’s pretty much the doctor writes for a drug but what gets filled is who will pay for the drug, PBM or patient cash price, because of collusion between PBM and manufacturing.

  • It​ appears that no actual pharmacist has sat down and given a good explanation so that he can understand the concept of generics and drug costs and pricing if this opinion and waste of the public tax money is spent on a wonder journey by Mr Grassley. He is so concerned about this ‘red herring’ when he could better focused on the real problems of corporate greed by PBMs colluding with drug companies, which tie the government payers in knots and ultimately the tax-payer citizens which bear the brunt of exorbitant and artificial prices. Show me any scientific data supporting the contention that generic drugs as a whole or specifically do not work, and I will tell you about the physician that insisted his patients needed brand-name Lasix even if they had to pay cash, and this was 25 years ago when the efficacy of generic medications had already been established, as well as the good doctor had investments in the brand-name company. Bogus argument. Why should we as a nation support the tax-supported prescription drug operation of another country when we could clean up our own act?

    • Apparently, you are not familiar with the issue, or the problems with generics. The concept that generics are essentially the equivalent of brand meds is, in many instances, a myth. Want proof – look(via Google) at the FDA’s finally, after years of complaints ordering 2 generics of Wellbutrin off the market, in 2012. Try finding an endocrinologist who is willing to prescribe a generic form of synthroid – generic versions are largely made overseas now – and have been found to be unreliable. Then do research on med blogs on the people who were on brand Lexapro, forced by their insurers onto generics, and suffered a serious relapse in their conditions. And if your doctor prescribes brand only, because his or her experience with a generic version of a drug has proven to cause serious side effects to patients, would you be willing to pay $200, when under your policy the copay for the brand is listed as $65. it appears, despite your pharmacy credentials, you have no familiarity whatsoever with what is going on – or at least want to steer patients away from finding out.

  • Mr Grassley is quite right in his assumption that insurers are overcharging. Even worse, the Pharm Benefit Managers that are the hatchel men for these people further penalize the patients by demanding that patiets try lower cost alternative treatments (not generic equivalents)before thay will approvea drug. This leads to weeks of appeals and denials before something is approved. ThePharm Managers can then turn to their insurance company and say “see we saved you 12% this year!!!!”

    • It is not the insurance company that starts with the overcharge; they’re along for the collusion with the manufacturer, and since there are no other suppliers, the argument that ideological ill-informed politicians keep handing out as relevant about a free market economy also plays into self-interested greed by law-makers.

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