January 03, 2018
Few experiences are more of a nuisance than realizing, mid-headache, the ibuprofen bottle is empty, sending you straight to the pharmacy aisle in the grocery store and face-to-face with a lineup of brands that all seem to do the same thing.
But that's just it: Do they all do the same thing?
Eager for a definitive answer, we reached out to Emily Hajjar, associate professor of pharmacy at Jefferson University's College of Pharmacy.
What is the difference between buying generic, store-brand ibuprofen and, say, Advil? Is there a significant difference?
From a medication or therapeutic medicine standpoint, there really is no difference between the brand-name and generic products. I think that, to the consumer, the biggest issue the consumer will face is price, and that can be an over-the-counter or prescription item. Because over the counter, it's obviously coming out of your dollars, and in a prescription, it's a copay. But therapeutically, there's not a ton of difference between a brand-name and generic drug.
I've read there's an efficacy threshold that determines whether the generic can qualify as an equivalent. Is that true?
Yes, when they do studies to show how well it dissolves or how much you get into your body, it has to be plus or minus 20 percent. It has to be close but not hugely different.
There are some drugs that are what we call 'narrow therapeutic drugs,' which means a tiny movement might make a big difference in the patient. With that, the brand could make a difference, but something like Tylenol, over the counter, you're going to get the same benefit generally and won't be able to tell.
That's a good point. I guess there might be a difference if it's something especially sensitive, like mood?
One drug that would be tricky to switch from name-brand to generic is sensory products, or something to supplement your thyroid...Sometimes people, how they absorb those drugs, they can be really finicky. A tiny level change might impact the patient--and it's not that we ever say 'Don't take the generic drug,' we say, 'Take one form of the drug and stick with it.' And get your levels monitored. Don't go back and forth between them. But Tylenol or Advil, I bet no one can tell the difference between a brand-name Advil or generic ibuprofen.
I've heard some generics will throw in additives, like caffeine. Any truth to that?
No, they generally don't add any more active ingredients and caffeine would be an active ingredient. The formulation can change, the constituents of the tablet, but those things are inert. It might be a different binding agent but it won't have any impact on you. Generally, if you're changing active ingredients you're changing the product, and that's not acceptable.
Does this apply to vitamins, too?
Those I'd say are generally the same thing [too], whether you choose the brand name or generic. The one thing I'm not sure of--when talking about herbal products, those aren't necessarily regulated anyway so we're not sure what's in the capsule. A company may say it's [this or that] and it may not be.
I'd say take what agrees with your body, [starting with] the generic formulation, and what you can afford.
The cost of drugs is always a hot-button issue. What efforts are being made right now?
So the laws say the pharmacist can substitute a generic. Let's say a prescription is written for a brand-name item; you can substitute the generic and that's generally how those things work. That's the legal way to do it. Sometimes patients say 'My prescription says Advil, I wanted brand-name ibuprofen,' and that's your right to have that. But you'll pay a lot more money. So, that is one of the ways the world is controlling cost, is to switch over to generics if they can.
Another way we're controlling costs, or trying to, is let's say there are multiple different types of drugs in the same category and some are generic and some brand-name. We often say you have to try a generic product before you can get a brand-name product. 'Let's try that and see if it works for you,' and if it doesn't and there's proof, we'll give the higher, more expensive medication. That's two ways we're doing a somewhat OK job of controlling costs.
What do patients tend to complain about?
Oh, I think they may complain they didn't know they're getting a generic and find it startling, and 'Does it work just as well?' 'My doctor used this term and you're giving me ibuprofen.' It's so intuitive for a prescriber to go back and forth between them, and sometimes we don't realize the patients don't know and that can be scary to them when they're expecting a different name. And that we could do a much better job with, because we want them to know what the pharmacist is giving them is just as good.
Is it hard to build a language around medication when mixing in all these different names for generics, and brands, etc.? Building a universal language for one medication when it has three names?
Yeah, I think it is very hard to do that. I think those of us who work with--I work with a lot of seniors, and I really try go to the extra lengths if I'm writing something down for them, to put the brand and generic name and, even when speaking with them, I try to use both names--Tylenol and acetaminophen. But I think unless you're really cognizant of it, it's so innate to healthcare professionals, it's hard to know we're not all speaking the same language. You can weave it in.
General tips as people peruse the aisle in the grocery store or pharmacy?
I personally use generic myself. I don't pay for the label or the fancy name. Generally, we put the generics right next to the brand name, so they can always find the branded products and I tell people to look to the left, or right, or up or down on the shelves near it to compare the brand--truly, from generic to brand-name. I think people get overwhelmed trying to find the generic but it is supposed to be closely located. And always be sure to ask someone.