5 Problems with Generics to Ponder

Generic drugs are cheap, effective, and FDA. So, what's the problem?

As a pharmacist and consumer, I’m thankful for generics. Something in health care needs to be affordable, and it certainly isn’t lab work, doctor visits, or hospitals.

Generics make life-saving drugs affordable to average-income individuals. They are a bit of modern-day medical magic, if you will.

But, as they say in the TV series, Once Upon a Time, all magic comes with a price.

The pharmaceutical industry's rapid transformation into a primarily generics-driven market has certain side effects that can’t be ignored. Generics have an interesting genealogy, and “like father, like son” doesn’t always apply in this family tree.

As a practicing pharmacist for just over 20 years, I have witnessed this medical metamorphosis of sorts firsthand, and pondered these 5 problems:

1) Variation. For better or for worse, generics introduce some measure of variation to the market. Even within the brand-name drug market, some degree of variation is allowable. But, our generically saturated pharmaceutical shelves introduce more potential variables than ever before. If there is only 1 possible omeprazole manufacturer, then there is some amount of variation to be expected. But, when you add 10 approved generics, the chances for variation seem much more significant.

2) More potential for dispensing errors. Assuming I’m permitted to propose an assumption based on my experience, I'll note that the odds of dispensing the wrong drug have increased with the multiplication of generics. Is it Dexilant or duloxetine? Is it oxycodone/acetaminophen or hydrocodone/acetaminophen? It seems intuitive that the sheer volume of generic drugs and generic names introduces some added potential for errors.

3) What ingredient is really “active"? In pharmacy, we make the helpful (or unhelpful) distinction between “active” and “inactive” ingredients. To some degree, such distinction always rests upon assumptions about patients and perspectives. Pharmacists want to believe the only thing that matters in patient outcomes is the molecule identified and measured as the active ingredient. But, who's to say tablet coating is indifferent or capsule color doesn’t matter? What if the filler ingredients do contribute to product failure?

4) Low profit margins. Generics have driven drug prices down, which is a good thing. However, as prices have fallen, so have the profit margins made on each individual prescription. As a result, the retail pharmacy industry has shifted to a high-volume, low-margin business, and this shift has consequences. Pharmacists' available time to speak with each patient has declined. The full impact of this on patient health is hard to measure, but we can’t escape the reality that these lower-cost options have altered our pharmacy operations.

5) Patient frustration. Switching to and between generics creates no small amount of frustration for patients. If you don’t believe this, then you haven’t worked very long in retail pharmacy. Even if we remove any possibility of clinical outcomes, we still are left with frustrated and sometimes confused patients when we switch to and between generics. Just the thought of 1 generic drug being better than another creates anxiety for some individuals, which psychologists call the "tyranny of choice.” When many choices exist, pharmacists are more likely to agonize over the possibility that they have chosen poorly, thinking the results would have been better if they only chose differently.

I neither oppose generics, nor disdain their dominance on my pharmacy's shelves. But, the very concept of a “generic” and the implication of its place in pharmacy is worth pondering from time to time. Perhaps, there is more to a medication than the active ingredient labeled on its bottle.