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Woah. I cant believe it.

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I am one of those drug reps that you hate see walking through the door but
I have to ask a serious question. Do you think that generic Coreg is
equivalent in efficacy/tolerability to the branded Coreg? Also, since there
will be 14 potential manufacturers of generic Coreg, will they all have the
same effect? Hasn’t there been alot of difference with the generics for
metformin? Maybe not? I would like serious responses because if generic
Coreg is as good as the branded then that will be great for your customers.
They will be getting the best beta blocker at an affordable price. How
about the patients that switch from branded Coreg or Coreg CR to the
generic? Do you see any problems in regard to potential decompensation of
their CHF? I know post MI and HTN patients will be different but the CHF
patient is a little more vulnerable. Also, how about the patient who has
the same co-pay or a little higher for branded or generic- would you
recommend that they switch to generic? This personally happened to me when
I got a script filled. I have the same co-pay and I was given a generic
without being asked. Wasn’t happy about it so asked for the branded that
the doctor wrote on the script.
Thanks for your serious reply.

I love it when drug reps use big words! Its so cute! But seriously, I dont understand how you can believe the stuff that GSK pounds into your brain and you extrude out of your mouth.

  • Tablet making isn’t rocket science. For the “variability” that you talk about, how do you know that the same “variability” isn’t present in the trade name? There isn’t some magical formula that the trade name company in making the tablets, and there isn’t some special machine that GSK has that proves equivalency between invidiual tablets that huge generic manufacturers (Mylan, QT, Watson, Dr Reddy) doesn’t already own. Their ass and reputation rides on their product much like GSK does. So yes, the tolerability and safety will be equivalent. Yes, generic Coreg is great for our patients HOWEVER your employer wants you to switch everyone over to their product so they continue to make a 5.8 zillion dollar profit and screw everyone over. Its business, plain and simple. If Coreg-CR was a superior product from the get-go, then they would of came out with Coreg-CR initally and not the IR. Amazing how GSK did the exact same route that Ambien and Paxil did; release an CR product when (gasp) their product just happened to go off of patent. I bet any money that Avandia-CR is in the works right now. You should of went the Clarinex/Lexapro route and purified an isomer to make doctors cream their panties when they hear about this ‘new discovery’.
    • You know what I’ve found with generic metformin? The patient eating birthday cake the night before he switched. Taking the new brand on an empty stomach vs always taking the old brand on a full stomach. I “don’t like the color” or “This one has the bad smell”. Yeah, totally irrelevant psychosomatic or outside variables that no drug company can compensate for.
      • With decompensation with CHF patient, if they are being treated correctly (meaning a Beta-Blocker, an ACE-I cranked up until cough then reduce by ~10%, Aldactone, lasix/K+) then they shouldn’t have any decompensation problems one bit. Of course Doctors dont want to put their patients on the “proper” CHF regime because its a lot of pills, so they just give them Coreg and some lasix and send them on their way (then wonder why they end up in the hospital).
        • If patients have the same copay between trade and generic (which they don’t), i’ll still fill the generic. Why? Because I dont want a $200 bottle sitting on my shelf when a $5 will do when there is no significant difference between the two. I’m on medication, my boss is on medication, and some of our staff are on medication. They are all generic (and we stock the trade name). Why? Because its cost-effective for the store, for us, and for our insurance companies. We do “the right thing(tm)” of our own free choice. I hate people who are so brainwashed that their doctors are some sort of deities and demand they get trade name Amoxicillin because their doctor wrote it on the prescription.
          So, its time to ask you a few questions:

          • Take like Toprol-XL, Lotrel (Sandoz Brand), Zocor (when it /first/ came out), etc. Know what all of these have in common? Their generics are made by the trade name company. Do you still whine and push your “not equivalent” propaganda when the Sandoz brand of generic Lotrel look exactly the same as trade name Lotrel? I know that GSK probably doesn’t do this yet, but when they do, will you still be pushing some new-product-x and bashing the generic when you fully know that the generic is made by YOUR company?
            • Seriously, how many free trips/dinner/fancy pens/lapdances/kickbacks/bribes/”incentives”/”rebates” do you bring to cardiologists to push your new drug? Do you just throw a bunch of studies in front of him, recite some numbers from a study that GSK funded showing (surprise) Coreg CR superior to God himself and throw schwag at him? Don’t you watch those infomercials on TV and wonder that maybe you are a real-life one? Don’t you believe that to practice “good medicine” the doctor needs to have a un-influenced (meaning no goodies) decision on what agent would be the best and safest for the patient found out on his own free will? If a doctor is “too busy” talk with ME, a licensed professional about his patients health and medication then why would he have enough time to talk with YOU unless you somehow benefit him with free goodies.
              • Do you tell him how expensive this shit is? I mean “I have this wonderful drug that will cure everything” sounds great, until you say “but it costs 34 kerjillion dollars a month”. Seriously, what doctor is going to prescribe something to a patient knowing full well they cant afford it? Oh, because you don’t tell them how much it costs. So I get on the phone, and I tell him “Uh, Mrs Smith has no insurance, and new-drug-x costs $200/month”. He/She goes “Oh, I had no idea, the detail person was just in here”. See that? By you omitting information, you just cost both of us time we did not need to waste.
                So I want you to do something. I want you to take a few hundred bucks, and throw it away every month for no reason. Then you’ll see what its like to have no insurance and have your Doctor refuse to switch from Coreg-CR because of someone like you.
                Told ya I didn’t like drug reps. Im sure you’ll get some colorful comments from other pharmacists who share my view.

Comments #

Comment by ThomasD on 2007-09-19 09:54:01 -0700 #

Almost total agreement from me.
My only quibble?
“Don’t you believe that to practice “good medicine” the doctor needs to have a un-influenced (meaning no goodies) decision on what agent would be the best and safest for the patient found out on his own free will?”
That’s really not up to the drug rep, it’s up to the physician (or any other practitioner) to decide what consitutes the good practice of their profession.
If a doc believes he can go to the free diners, take the junkets, goodies, samples, etc. and still act in the best interests of his/her patients so be it – unless and until the profession as a whole says otherwise.
Practically speaking I know alot of docs really cant do so. Simple example. I recently got a new rx for Geodon for a patient with poorly controlled type II DM. I cringed, but knowing the patient and the doc, tried to fill it anyway. Her part D plan rejected it, requesting either Risperdal or Seroquel as preferred agents.
Upon informing the doc he repsonded asking if I could come up with something other than the preferred agents – something that ‘would not cause weight gain.’
Yep, you guessed it, one week prior the Geodon people had been in town to put on a dinner (no CE of course – telling anyone with a clue that it was going to be totally biased advertising.)
So in that one sense I cannot fault the reps, or the drug makers, for pushing their product, I fault the profession(s) who buy into their patter.

Comment by Debbie on 2007-09-19 10:16:24 -0700 #

I am an RN that worked for years in large Internal Medicine clinic. My LEAST favorite thing about the job (and there was lots of competition for that coveted title) was the constant stream of drug reps interupting my day. The men would flirt with me (unwelcomed) and the women would act as tho we were old,dear friends.(also unwelcomed). “Debbie do you think I could get a few minutes of Dr. so-and-so’s time….” SO glad I dont have to deal with them in my current position!
And on the topic of DAW’s dont get me started!We had some patients that claimed to be “sensitive” to all medications so ALWAYS had to have DAW. These patients are always on about 10 meds, so they are either costing the taxpayer lots of money if they are on the gov’t dole, or causing their coworkers premiums to go sky-high because employers insurance costs are determined by usage.
I’ve just found your blog, Mr. Angry Pharmacist and now its a daily “must read”. Whats been your experience now that Ambien is gone generic. Are patients crying for DAW or does the generic seem to work as well.

Comment by Linda on 2007-09-19 10:27:13 -0700 #

I have been in medical sales for my entire career, ten of those as a drug rep. I am a professional woman, I dress professionally, and hopefully I bring decent information to the doctors and pharmacists that I call on. Drug reps are not prostitutes, nor have I ever “sucked anyone’s….” to get business. I have never been out on a date with a doctor. I seperate business from my personal life. Two things are going on here and I know that you are just going to slam me but I will say it anyway. Normally I find your blog funny, as I do have a sense of humor. I too think that the industry as a whole needs some repair. But maybe, just maybe, you have interviewed for a position as a drug rep, and you just don’t cut it? So you are disgruntled? There is alot more to being a rep than throwing out pens, ect. I will put my knowledge of the 4 drugs that I sell up against any MD or Pharm any day of the week. You and the docs have to somewhat know the PDR, we have to know our products.Or maybe, you are a fat,ugly nerdy type with no personality, and a good looking woman ( drug rep or not ) will not give you the time of day? Because your anger towards women in general comes out loudly. Normally I laugh at your blog, but your anger has taken a dark turn towards people who are just like you, trying to make a living in an increasingly difficult world run by insurance companies. And one more thing, as you rail against people and their habits or addictions. ( pain pills, ect ) Alcohol is an addiction too…you just are able to buy it in any when you talk about your drinking in relation to the people that you despise with addictions to rx-meds, perhaps you need to look in the mirror? Later TAP.

Comment by Chrissie on 2007-09-19 10:31:31 -0700 #

I’m always curious to read about the generic vs brand name debate that goes on in the US. I’m a pharmacist in Canada. When a generic becomes available, everyone gets switched. Period. The end. Because the insurance plans will only pay for the cheapest version of the drug. If they had a $5 copay on the brand name and the generic is suddenly $40 cheaper, if they want the brand, they must pay the $40 difference plus the copay. We’ve had a few people with legitimate need for the brand name, in which case, the doctor must write No Substitution on the Rx and that’s good enough for the insurance companies.
What blows my mind is how doctors get a bug in their mind about a certain drug, regardless of the cost. I work where there’s an after hours clinic and my god everyone comes over with Biaxin XL for 7 days. At $80+ per Rx. And when someone can’t afford it, the Dr readily changes it to Amoxil 250 tid x10. I mean really – why not go with Amoxil to start??

Comment by Surgeon in My Dreams on 2007-09-19 10:34:33 -0700 #

Wow. I just frigging LOVE you!!!
I’m not in the medical profession, just a wanna-be, but, my husband does take a butt-load of medications and will lose his insurance (COBRA)on Oct 4th.
Every application we have submitted has come back non-insurable because of his diabetes, thryoid, chronic pain, etc.
You keep up the good work. Don’t take any of that bullshit the pharmaceuticals spew forth. Continue to tell we little people out here the truth about things!!

Comment by Sarcasm, Pharm.D on 2007-09-19 10:36:31 -0700 #

Fucking balls, Pillman!!! I think she’s right! You know, we should set up some sort of agency to prevent all these generic companies from producing inferior products…I know…a government agency. The purpose of this agency will be to test the bioequivalency of each medication and further police good manufacturing practices. This agency will be bound by the tri-partite…oh…what’s that? Hang on, this breaking news is just coming off of the wire…oh, we already have that.
Well, that’s all the news we have for this evening. Back to you GSK rep.

Comment by JR on 2007-09-19 12:02:20 -0700 #

Hello Mr GSK Rep. Just be sure the next time you visit to bring in your
” tribute ” . Im talking about those wonderful coupon checks for the advair inhalers. Without them I will dispatch you like ming the merciless. Also I love when I take a trip over to the local doctors office and take his entire shelf of your coreg cr for a ben franklin. Its funny we both laugh our ass off about you Crs but we are both happy to make money on your dime.

Comment by Gary on 2007-09-19 12:16:01 -0700 #

another great post AP. i personally love how generic lotrel made by sandoz says “LOTREL” right there on the pill…haha

Comment by Cathy Lane RPh on 2007-09-19 13:49:13 -0700 #

As a registered, licensed graduate pharmacist of a pharmacy school, I would beg the validity of the rep’s assertion in her argument that that she/he knows the ins and outs of the four products she’s selling. Most pharmacy school grads have taken every single course in the curriculum and therefore have studied all aspects of drugs and pharmacological therapy, etc. and are well aware differences of each product in a drug class, not only four different products in four different classes (from what the PDR says about them). Unless the rep can come up with the expertise of discussing differences among products, as well as differences in therapeutic agents and treatment modalities, then I would say she/he doesn’t really know what they are talking about. I know pharmacists who’ve been, or are reps, and I would tend to trust/ believe their spiel as an equal long before someone who hasn’t studied pharmacy from all angles. Sorry! As for alcoholism, totally against it, but then there are teetotalers out there in every field!
As for the free meals, pens, etc. I partake if offered–opportunities for discussion with a rep are few and far between in this neck of the woods, and it never hurts to hear what will be the latest argument, or enjoy a good chuckle, but feel little bad about the influence of the pens as they get used until someone takes them.

Comment by PharmGirl on 2007-09-19 14:19:48 -0700 #

To the drug reps,
I am a pharmacist, I have been on the otherside(drug rep) and the co’s you work for feed you A LOT of crap!! See, we are EDUCATED in drugs, pharmacology, and therapeutics. You said, “I will put my knowledge of the 4 drugs that I sell up against any MD or Pharm any day of the week. You and the docs have to somewhat know the PDR, we have to know our products.” Funny how you know only 4 drugs and I have to know them all. Oh, and the studies that you know only paint your product in a good way. Have you looked your product up on your own or done a medline search to find out other studies that involve your 4 products or do you only know what your co. feeds you? What you “KNOW” about your products is what your co wants you to know. Do you honestly think we just “know” the PDR and that’s it??? Did you know that co’s PAY to have their info listed in the PDR?? Yes, that’s right, your co. pays to have their info listed!! I hear a wrinkle being formed b/c I bet you didn’t know that…Bottom line, we are the patient care advocate, not you, you’re a SALES PERSON, I’m a healthcare proffesional!! If you don’t like it, tough! I have an opinion and I like it, that’s why I have my PharmD and you don’t! I honestly find this to be a very real reflection of society and deadbeat people we have to deal with on a daily basis and this is a must read for me!! AND ps, I can’t spell either!

Comment by JustATech on 2007-09-19 14:38:41 -0700 #

We call quite a few doctor’s office to have medications changed when a brand name isn’t covered anymore. In the province I work in, if a person has provincial coverage (read “most seniors”)and a generic is available, the plan will pay generic cost only. A lot of employer plans and private plans are the same as well. If it’s a fairly new medication released onto the market, like recently Prexige, a provincial plan won’t cover it at all and the person is stuck paying out of pocket for hundreds of dollars.
When the pharmacists call the office and suggest to the doctor that a different medication is covered by the plan, we get asked, for example “how much do 14 Biaxin XL cost?”
When we tell them “in the neighborhood of $75, and the Amoxil is $18 (with only a $6 copay for the patient)” you wouldn’t beleive how many docs say “wow…. I didn’t realize that… give them the less expensive med.”
I don’t think docs have any clue how much meds cost. I think they should all be forced to keep a few wholesaler catalogues on hand and look up costs (an factor in dispensing fees etc) when prescribing. We also all know that doctors get oodles of medication sample packs… even for things like inhalers and antibiotics. Keep your patients in the loop. Make them ask for samples on stuff like this.

Comment by StephRx on 2007-09-19 14:56:21 -0700 #

Oh NO she di’n’t. Did she? We have to “somewhat know the PDR?” Ta-ha! TA-HA! Oh, well, guess what? Some of us somewhat know the Ovid and PubMed and read actual studies, too! Oh, some of us have Micromedex and some of us are lucky enough to work with pharmacists who prepare very comprehensive literature reviews. I wonder…does Miss Fancy Pants do literature review? Does she even know what that entails? Does she know we can read right through her company-sponsored “studies”? TAP, take it from me: You. Are. HOT! Pass me a cerveza. I’ll drink to you any day.

Comment by PharmD to be on 2007-09-19 15:21:56 -0700 #

Response to Linda:
“I have been in medical sales for my entire career, ten of those as a drug rep….”
Really, I dare you to say you know more than a pharmacist about the kinetics, MOA, chemistry, side effects, efficacy of a drug than a pharmacist. I bet I could rattle the chemical structure of a beta blocker and describe its structure activity relationship (aka what carbon does what) in such detail as to why the drug works in the way it does in terms you’d have no clue about. Kinetics? I’ll use equations you’ve never heard about to show you the generic is equal to the brand… MOA? You have no idea where the beta receptor is let alone how your drug blocks it. Want more? In order for a generic to be FDA approved it has to have 3 things equal: the area under the curve, the time to peak, and the maximum concentration seen with each dose in the body. After these three are deemed the equal… what else is there to be different? But you probably don’t even understand what those three things are… because your wonderful drug company hasn’t told you that part since it’s not in their best interest.

Comment by ThomasD on 2007-09-19 16:32:12 -0700 #

Hey, here’s another drop ship, what could it be?
Xyzal (levocetrizine) 5mg tablets.
Zyrtec (cetirizine) must be going off patent any time now…
Yeah, patients really need this stuff. Zyrtec being known for a lack of efficacy and intolerable side effects…
But some fool will undoubtedly prescribe it anyway.

Comment by PharmGal on 2007-09-19 19:43:31 -0700 #

I have a word for the sweet little drug rep. First of all, the “best beta-blocker” for every patient is not necessarily Coreg. I’m sorry, it’s not. Second of all, do you believe everything your drug company tells you? And why is everyone so freakin scared of generics? I take generics all the time. THEY ARE FINE! THEY WORK THE SAME.
Angry, you’re the best. The other day when I was listening to a drug rep go on for an hour about why Symbicort was better than Advair I thought about you.
And about those fancy pens, the drug rep for Lantus definitely brought us white feather pens. Like the kind you have out for guests to sign at your wedding. What a waste of money!

Comment by drh on 2007-09-19 21:24:06 -0700 #

You’re the greatest–I know I’ve said it before, but you are, and I’m not a stalker.
I’m sure it’s true (because you’re a god and I believe everything you say), but I find it hard to believe that other docs really get taken by all these Clarinex/Nexium/
Paxil CR/Lexapro/Cipro XR scams. Where did these idiots go to medical school? Is it just the male doctors (because of the blow jobs) or do other women do it, too?
One of the best things about working urgent care and mostly evenings and weekends–NO drug reps!!! Plus, I pretty much prescribe antibiotics (many fine generics available), prednisone, albuterol (I do personally think the HFAs suck), and, when I can’t prove they’re scammers, Vicodin (never Soma). Therefore, I don’t need to deal with all the CRs of the world much.
I do get the occasional patient who demands to have DAW on their script (universally these people are crazy) despite my explaining to them at length (or as much time as I have to waste on them) why they’re an idiot without actually coming right out and saying it. Eventually, I will just write it to get them out of my office (before they come up with 10 other complaints I have to deal with). I stress to them that THEIR INSURANCE WILL NOT PAY FOR THE BRAND NAME AND NOBODY IS GOING TO DO ANY PAPERWORK TO TRY TO MAKE THEM (because it’s one area where the insurance companies are actually right). Sorry, cuz then I know they come and bug the crap out of you, but sometimes I just can’t take it anymore…

Comment by Enrico on 2007-09-19 21:39:41 -0700 #

Actually, I was going to reply to this commenter in the last post, only to come back and find it is the new post. Wheee!!
It was very telling that she herself demanded the brand name over the generic, showing the extent of the stormtrooper programming.
My main point was that whatever MINISCULE difference may exist if at all (there’s rat shit in the Kellogs Mueslix you eat, you know, it’s just under ‘safe’ levels) between Coreg(tm) and carvedilol, if that quantum mechanically sized difference is enough to decompensate your CHF patient, then any sane doctor would know they’d have no goddamn business being outside the hospital. And what at-risk CHF patient would just be on Coreg? No diuretic? No cardiotonic? No other variables to worry about? Hmmm? Give me a break.
And learn your basic pharmacology, will you? Carvedilol is an beta AND alpha blocker, so it (like labetalol, probably your “enemy” drug) decreases TPR simultaneously, making it a “1-2” punch. Don’t lump it as a generic b-blocker.

Comment by rph3664 on 2007-09-19 21:43:48 -0700 #

Linda, how much contact do you really have with pharmacists? WE DO NOT USE THE PDR. Every pharmacy I’ve ever worked in has had one on hand, but how often is it used by us? Essentially never. It’s okay for the non-pharmacist but we do not use it for a multitude of reasons, the main ones being that it is incomplete and accessing information is difficult.
I did clinical rotations on an Indian reservation whose formulary was controlled entirely by the Federal government. Did we get drug reps in this hospital 40 miles from the nearest town of any size? Yuppers. Did they have any influence on our prescribing? Of course not, although we did appreciate the pens and notepads. And my preceptor, after they left, would go to the sink and do a surgical scrub of his arms.
In my old town, I had a neighbor who was a drug rep. She was actually a very nice person, and definitely not a bimbo by any stretch of the imagination.
Yeah, I remember when Paxil CR showed up, and dropped off the radar almost as fast. However, I have had people tell me personally that Nexium did work better than Prilosec, and one of them was my grandmother who died earlier this year at age 91. She actually considered the $150 a month she paid for it before I got her a “Together” card (reducing the price to $15 – I still have the thank-you note she sent me) to be money well spent since it so dramatically improved her quality of life.

Comment by Enrico on 2007-09-19 22:01:26 -0700 #

I should mention that my previous comment was directed at the original drug rep, not TAP. THIS comment is directed at “Linda.”
Stop. You had me at “sales.” That’s all I need to know. You can hold your own against an MD/RPh/PharmD on 4 drugs? FOUR?!? Honey, give me those 4 drugs, invite a friend with another 4, give me a few days, and I’ll embarrass both of you (as a med *student*, no less).
Why? Because when you actually GO TO SCHOOL for this stuff, you’ll learn a whole lot about a whole lot you can’t even imagine that doesn’t come in the slick binders they give you to study. It’s not in the Powerpoint presentations they’ll give you at marketing camp. There’s so much a drug rep (salesperson) doesn’t know that is critical to REALLY understanding what YOUR COMPANY’S cash-cow-du-jour does, I can’t even begin. No I don’t know the latest bullshit study funded entirely by your company; no it never crossed my mind it could be used off-label for priapism; and there just might be some useful light shed on this or that, but 90% of the time, it’s not going to be worth the small talk, the pitches, the fakery.
I don’t doubt your professional integrity, but never, EVER forget you are a SALESPERSON–nothing more, clinically.

Comment by driving miss delusional on 2007-09-19 22:20:54 -0700 #

linda said: “But maybe, just maybe, you have interviewed for a position as a drug rep, and you just don’t cut it?”
And I almost choked on my poptart. Yeah, I bet most pharmacists head straight for the “help wanted in sales” section of the classified after they finish their doctorates.

Comment by Sara aka one angry tech on 2007-09-20 05:57:13 -0700 #

I love when drug reps come in and bring pens.. we fight like wolves over ’em.
And why the hell do they always come in when we are busy,, they observe that we are busy, know we are busy, yet insist on talking to the pharmacist who the whole time is busy trying to *gasp* do his job and counsel patients, verify medications, etc.
The only question I have for them is “Do you have any pens?”
“No- I have note pads though”
Ok.. good bye and I happily return to my hole.
But seriously, we had one patient who was notorious for her “generic allergies” until her insurance jacked it to her and charges her $20 for name brand.. now her allergies magically dissappeared! <3

Comment by Trusted.MD Network on 2007-09-20 06:11:39 -0700 #

The Angry Pharmacist takes on drug reps

Always an entertaining read. Keep fighting the good fight my friend.

Comment by Dr. RJ on 2007-09-20 08:27:02 -0700 #

I hate to burst some bubbles, but there are significant differences in efficacy between generics for Zoloft and Celexa. Generics for Prozac, thank God, all seem to work just fine. Any generic imported from India (esp. Dr. Reddy’s) is suspect, and heaven help us when China starts flooding the box store pharmacies with their generics. (as opposed to their counterfeits they are so adept at creating)

Comment by Ann on 2007-09-20 08:34:45 -0700 #

Original drug rep poster here. Well I guess that my question was answered in regard to pharmacists opinions as to generics being equivalent to branded meds.
Hey, I am not a pharmacist nor do I believe that I know more about any of my drugs than a pharmacist does. However, I do believe that I know more about the drugs I represent than do some, not all but some, doctors I call on. As many of you posted, you are or would take a generic instead of the branded drug which tells me that you have total faith in all of the generics available and all of the companies that manufacture them. I am the first to admit I do not know the exact regualtions that a generic manufacturer goes through to get their drugs approved, but I did get on the FDA website and this is what I found:
Among the task force conclusions was: “FDA is prepared to use a more stringent criterion if differences of this size [e.g., the 90% confidence interval for the ratio of the test product mean AUC to that of the innovator must lie entirely within the interval (0.80-1.20) (now 0.80 to 1.25 on log transformed data)] are shown to be clinically significant.” No clinical data has been submitted to the Agency in the ten plus years since the hearing that would warrant the Agency narrowing the present confidence interval of 0.80 to 1.25 on any drug or class of drugs.
So help me out- there definitely could be a variation in the generic vs the branded- .80 to 1.20? Is this much or not? How about for the drugs with a Narrow Therapeutic Index- i.e branded warafin vs. generic?
Profit is the bottom line for big pharma and pharmacies- so obviously generics are more profitable for the pharmacies and branded are more profitable for the pharma companies.
We all have a job to do and I respect pharmacists very much. One doctor told me that the $4 Walmart drug list has gotten more patients medicine than the government which I totally believe and now generic Coreg is on that list. And to one of the posters above, I understand that Coreg has alpha 1 receptor blockade too but 99.99% of doctors lump Coreg into the “beta blocker” class. I guess that here I am talking to people that know this because most doctors have NO idea why Coreg is different than atenolol, metoprolol, toprolol, propanolol, etc. and have even asked, “well why then if Coreg’s alpha blockade is a good thing, why just not use labetolol?”
Thanks for everyone’s input and just remember when the drug rep comes into your pharmacy, they are only trying to do their job too! Also, believe me, there are PLENTY of patients getting switched or starting on the generic Coreg-its on the $4 List at Walmart and patients bring the list in to their doctors and asked to be switched to the medicine on that list. NP’s and doctors do not like it but what can they do????

Comment by Maryambn on 2007-09-20 09:07:35 -0700 #

G’day, I fully appreciate the fact that Drug Companies are just out to make a buck and releasing ‘new and improved’ versions when their patent runs out is a scam.
But on the Cipramil versus Lexapro thing, I have experienced a difference between the two. On Cipramil (for over a year) I suffered from anorgasmia (I’m female btw.) I had never had a problem like this until going on Cipramil. It was so frustrating I finally asked my doctor to switch medications. I briefly tried fluvoxamine (brand name Luvox) which had other side effects until my doctor then put me on Lexapro. With Lexapro I have had no problems with anorgasmia at all. That’s for over a year now too.
So I know that one patient does not a double-blind study make, but I just wanted to point out that in this case, the new and improved version really was new and improved for me.

Comment by BlueTech on 2007-09-20 09:57:17 -0700 #

I have a question, your angryness. My psychologist (who, thankfully, has never prescribed _me_ anything) insists that Generics only have to be within +/-20% of the brand potency? Is he bullshitting me? I’m kinda skeptic, seeing as I’m a freakin pharm tech. Wouldn’t that make, say, generic warfarin kind of…dangerous?!

Comment by Tyler on 2007-09-20 14:55:27 -0700 #

I could wow you with my pharmacy/medical knowledge or belittle you with fancy words, but instead I’ll just tell you what a fucking cunt you are!! We shudder every time you reps come in. we see the shirts you wear that were obviously balled up on the floor not to long before. You waste our time with your stupid propaganda. Please die, k thx bye

Comment by Dean C - Blo, NY on 2007-09-20 19:18:24 -0700 #

If I have to hear one more fucking drug rep talk about “particle sizes”, I just might kill myself. I kid you not.

Comment by Tiny Shrink on 2007-09-20 19:49:24 -0700 #

Ann, I appreciate your questions; they’re honest questions and you’ve tried to do some research. It sucks that your training didn’t teach you much about confidence intervals; they’re basically saying that they’ll change that criteria if and only if it’s shown to be clinically significant. Any confidence interval containing 1.0 is not statistically significant, so they’re saying that the area under the curve should be around 90% of the trade name drug and the differences between the two should not be statistically significant.
Linda, your comment made me almost pee on myself I laughed so hard. Except I don’t think you were trying to be funny. Oops!
TAP, I’ve heard one reason to prescribe Paxil-CR vs. regular Paxil, ie that patients can actually experience withdrawal symptoms between doses of regular Paxil. It’s not a drug I’d probably use in either form unless a patient were already taking it or was resistant to most other SSRI’s, but it would be one reason to prefer the CR to the regular.
As an MD-to-be (within 1 year), could one of the pharmacy people tell me how to get one of these wholesaler catalogues, or some reference material to the cost of medication? Our education lacks this information AT ALL, and I honestly don’t even know how to get it (other than $4 at Wal-Mart or googling a drug’s price). I think if this information were more readily available to the MD’s, there would be fewer phone calls from the pharmacist.
I wish I could say more in defense of the MD’s, but I’ve seen too much of this crap to do so.

Comment by SCG on 2007-09-20 21:07:53 -0700 #

Did you know that the mechanism of Lumigan is that it binds to the Lumigan receptor? I had NO idea!!! Luckily a rep from Allergan set me straight. Whew, I would have looked like a real dumbass talking about prostaglandins and stuff.

Comment by Chadwick on 2007-09-21 10:32:30 -0700 #

Remember, dear, they use the good Carbon atoms in the Brand Name drugs. The generics get those bottom of the barrel “flimsy carbon atoms” that no one really wants.
Oh, and for what it’s worth, I think Greenstone generics are manufactured by Pfizer if I remember correctly. I love it when anyone makes a comment about “genetics” not being the same when it’s a Greenstone Pfizer generic such as azithromycin.
And the most beautiful of all:
Brand name Lortab/Norco/etc.
It says right on the brand name bottle, manufactured by Mallinckrodt. The generic company, that some will often refuse since it’s not watson, also manufactures the brand name.
I just don’t know why people believe this “brand name is so much better” horse shit.

Comment by Phil McCubbin on 2007-09-23 05:40:07 -0700 #

I feel sorry for this drug rep.
Her company’s goal is to sell their product, not provide good information.
She sounds pretty clueless.

Comment by Franklin on 2007-09-23 16:42:13 -0700 #

[email protected]
Ann: Wake up! the same confidence intervals apply to the pioneer drugs. When the FDA studied 4 generics thought to be critical for health vs. the pioneer drugs they found that the differences in bioequivalence between the generics and the pioneer drug were no greater than those among samples of the pioneer drug itself.

Comment by drugmanrc on 2007-09-23 19:57:39 -0700 #

I believe that quote from the FDA also includes the branded product: IE a drug lot from the branded product’s manufacturer must be within so many standard deviations from the mean for the AUC as well as the generics. For a drug to be considered “bioequivalent” to its standard three things must match within a certain percentile (Tp, Cmax, and AUC). Both brand name products and their generics must match those three things to the “standard” which is determined during the drug’s clinical trial. The generics get an “AB” rating if they considered bioequivalent. If not, they get a different rating (IE BX, etc) and are not legally allowed to be substituted for the brand name product. Manufacturers of both the generic and brand name products must perform various tests on each lot of product to ensure good manufacturing processes (disintegration, dissolution, etc tests) They must keep documentation of those tests for the FDA to review during inspections and in the case of a recall. These are just a few of the things that go into the approval process. I’ve posted a few links below for the interested:

Comment by drugmanrx on 2007-09-23 20:03:25 -0700 #

PS: For all those generic haters out there. Here is what the FDA says about them.

Comment by drugmanrx on 2007-09-23 20:08:16 -0700 #

“Is my generic drug made by the same company that makes the brand-name drug?
It is possible. Brand-name firms are responsible for manufacturing approximately 50 percent of generic drugs.”
Straight off their website found here:
Wake up morons; its the same shit in a lot of cases!

Comment by Brandon on 2007-09-24 23:38:38 -0700 #

“Among the task force conclusions was: “FDA is prepared to use a more stringent criterion if differences of this size [e.g., the 90% confidence interval for the ratio of the test product mean AUC to that of the innovator must lie entirely within the interval (0.80-1.20) (now 0.80 to 1.25 on log transformed data)] are shown to be clinically significant.” No clinical data has been submitted to the Agency in the ten plus years since the hearing that would warrant the Agency narrowing the present confidence interval of 0.80 to 1.25 on any drug or class of drugs. ”
Uhm, if it doesn’t have at least a 95% confidence interval, it isn’t worth a diddily. Also, your CI of 0.8 – 1.2 is also absolutely asinine. Ya know what that CI crosses? 1. That means that it is not applicable. 0.05 of less for a good study to be statistically (and therefore clinically) significant, dear…Clinical Epidemiology anyone? #

“insists that Generics only have to be within +/-20% of the brand potency? Is he bullshitting me? I’m kinda skeptic, seeing as I’m a freakin pharm tech. Wouldn’t that make, say, generic warfarin kind of…dangerous?!”
These are the ‘regulations’ mandated, but I promise you, *NO* generics on the shelf are that far off. I’ve been told by a past teacher that now works in the patent office for ANDAs that no generic drugs have ever been off more than 1-2% — the drug reps would have a field day with Mylan, Teva, et. al if that were the case…

Comment by John on 2007-09-28 17:34:59 -0700 #

Imagine the frustration
of being a staff phamacist,
following the rules to the T, making bagging errors,
being reprimanded, (let go)
this decision being made by management and they do not even know you, or talk
to you, or have never talked to you. Store
extremely busy, no one cares, real rip off.

Comment by Future Pharmacist on 2007-10-01 02:26:01 -0700 #

In relation to the Sandoz/Lotrel the same thing happened with Omnicef/Cefdnir

Comment by interns-r-us on 2007-10-05 18:44:34 -0700 #

dear ann (drug rep)-
you are a moron. if you had any iota of intelligence about what you where spoon-feeding doctors, you would know that a 0.80-0.12 confidence is sooooo statistacally insignificant it’s irrelevant. This range encompasses the error bars, so it’s really rather small. Being a current pharmacy student, i am actually LEARNING this in pharmacokinetics right now… oh also i’d love for you to explain are under the curve, tmax and cmax….that would be amusing 🙂

Comment by interns-r-us on 2007-10-05 18:44:56 -0700 #

dear ann (drug rep)-
you are a moron. if you had any iota of intelligence about what you where spoon-feeding doctors, you would know that a 0.80-1.2 confidence is sooooo statistacally insignificant it’s irrelevant. This range encompasses the error bars, so it’s really rather small. Being a current pharmacy student, i am actually LEARNING this in pharmacokinetics right now… oh also i’d love for you to explain are under the curve, tmax and cmax….that would be amusing 🙂

Comment by Dr Hobbes on 2007-10-15 07:04:41 -0700 #

I’m a retail pharmacist, and I attend every drug promo dinner I’m invited to. Lately, I’m invited to less and less, because there is nothing I love more than a little after dinner fun. Last week, I attended a “Stroke Prevention” promo (it was my favorite steakhouse, and since there was no CE, alcohol was freely served). The neurologist giving the talk asked something about “how many of you use TPN within 4 hours”, and since nobody answer, he asked “are you all nurses and pharmacists? are there no doctors in this room?”, so I replied “Most of us ARE doctors, just not MDs. This is a talk about drugs right? Who do you expect is interested in DRUGS??” To which he replied “Fair enough”, and spent the rest of the lecture defining “big words” and explaining stuff I learned in high school. I didn’t even stay for the fun Q and A at the end (where I ALWAYS ask “my patient just went in the “hole”, what do you suggest I tell him when he can’t afford your $400 drug?”. After my ribeye, I pretended to check my cell and got up and left. Others followed. I think the BI rep is NEVER going to call me and invite me again!!! So there is ONE think I like less than Doctors being influenced by propaganda, and that is the one hour long informecials. I tell all the pharmacists “If we fill the room, there will be less doctors writing this shit next week!” So what the hell, keep them coming.

Comment by Vivienne on 2010-03-18 14:03:45 -0700 #

The pharmeceutical companies are making a fortune to begin with on all of these drugs and especially the name brand. I am a RN and work in hospice and we use a lot of generic drugs and our patients are kept comfortable. I also know, because we purchase drugs for our hospice pharmacy, the difference between wholesale and retail and it is ridiculous. Everyone has a right to good health, unfortunately in many ways you have to be very wealthy or very poor too have it. Although with all the cuts being made by medicare, medicaid,and insurance companies even poor people may not have that benefit.

Comment by Betsy R on 2010-11-27 22:40:14 -0800 #

Many meds have been overpriced for years. The insurance companies forced the insured into plans where they thought they were getting low copays, while jacking up the copays all the time. I think it was a monopolistic plan to yank business from the local pharmacies into the mail order giants.

Took me a while to convince my mother that she could get a lot of her meds cheaper in town for $4 for 30 days or $10 for 90 days instead of using her insurance mail order, that she just had to \refuse\ to use her insurance.

Truth is, meds should be cheaper WITHOUT insurance – should be less work for the pharmacy, nothing to submit.

Yet, unfortunately, the medical and drug professions have evolved into a weird system with different classes of people being charged all kinds of rates, a practice that would be illegal in any other industry.

Usually, the uninsured pay more for medications than the private insurance or government-negotiated rates.

I have seen the $4 prescription list, which is not just offered by Wal-Mart, on the wall of many doctor’s offices.

So why is there so much bitterness about it on The Angry Pharmacist?

Comment by Ann on 2017-04-27 20:13:50 -0700 #

Sadly, in a lot of cases does nothing to stop the inferior product from killings someones loved one! Cheap crap legal and illegal make their way onto Pharmacy shelves! Gluten fillers, ect. Make people sick and all generics are not equal in ingredients. Psychosomatic labels are a cop out for Dochors with their head in the sand!