Drugs A Good Option For Many Senior Citizens

By Nancy K. Crevier

A study released recently by Medco Health Solutions, Inc, a drug benefit manager that handles prescriptions for about 20 percent of Americans, suggests that senior citizens who are part of the Medicare Part D prescription drug plan switch back and forth between lower-cost cholesterol lowering generic drugs and brand name drugs, depending upon if the cost is out of pocket or picked up by the government.

Despite the potential cost savings, the Medco study “found that nearly two-thirds of prescriptions initially filled by patients in Medicare were for branded medications. The majority of seniors only switched to generics after they reached the point in spending when users must pick up the whole cost of prescriptions,” according to an Associated Press report.

When drug costs reached the “catastrophic” phase and are again covered by Medicare, more prescriptions are for branded drugs, Medco found.

The experiences of a small group of senior citizens in Newtown and one of the local druggists suggest otherwise, though.

It is really a small minority of senior citizens that opt for a branded prescription medication over the generic brand at The Drug Center on Church Hill Road, said Richard Gubbiotti, a pharmacist there, for cholesterol medications or otherwise. “Most go with generic medicines and for the most part, the insurance plans do require that the patient use generic medicines when they are available,” said Mr Gubbiotti.

By and large, he said, the only time that patients purchase brand-name medications is when a generic is not available or when the doctor specifies that only the branded medication be dispensed.

Eight members of the Newtown Senior Center, half with private insurance, and half with state, Medicare, or VA insurance plans that cover prescription drugs, said that for the most part they use generic drugs, mainly because that is what their insurance plans require. “I use generic drugs for my heart problems,” said one gentleman with the Medicare Part D plan, “but I am not comfortable with that. I don’t believe that the generic drugs work as well [as the branded medications] and I am forced to use the generic. I think if a doctor tells you one drug, that is what you should take. There must be some difference,” he said. Nonetheless, he has not experienced any negative effects taking the generics, he said.

Some branded medications are automatically switched to a generic drug when a prescription is renewed, said several of the senior citizens who shared their feelings about generic drugs with The Bee. “I guess the doctor requested the change, but I’m really not comfortable taking the generic,” one woman said.

Others said that so long as the doctor approved the switch, they had no problem taking a generic drug. “I don’t mind it,” said one participant with a private insurance plan. “The price is much cheaper than what I paid before.”

Another said that she always makes a point of asking her doctor if a generic drug is an option whenever she gets a new prescription. “I take one drug that is not available yet as a generic drug, so I ask my doctor for samples. You have to be sure and ask your doctor, and I think that the generic drugs are just as good [as the branded names],” she said.

One senior citizen takes a generic drug for bone density, and has no qualms about the quality of the drug. “But if the drug were for a heart or kidney issue, for instance, something very serious, I would question whether the generic was as good a choice [as the branded medication],” she said.

A ‘Comfort Thing’

Of the eight senior citizens, seven said that if there was no cost difference and insurance did not have a say in whether branded drugs or generic were issued by the pharmacist, however, they would opt for the branded drug over a generic drug. “It’s a comfort thing,” one man explained. “I think the original drug is probably better.”

People are apprehensive at first when they switch from a branded drug to a generic drug, agreed Mr Gubbiotti. “Some of the medications may require new lab work, they are used to what they have been taking, and the amount they take may be different. It does require some reassurance from the doctor and the pharmacist,” Mr Gubbiotti said. He sees very little need for concern, though.

What is called an “AB generic equivalent” is the same both in the content of the medicine and the bioequivalence, or how it is released in the body, he said. Occasionally a patient will express concern about the fillers and binders of a generic drug making a difference in the drug action, Mr Gubbiotti said, but unless a person has a specific allergy that needs to be addressed, there should be no more problem with a generic than with a branded drug.

Lipitor is one cholesterol-lowering medication that many senior citizens take. When the generic Atorvastatin became available, some clients hesitated at first, Mr Gubbiotti said. “But cost certainly can be a deciding factor. Lipitor can cost around $100 a month. The generic is somewhere between $15 and $20 a month. For those with Medicare, this is important. It will take much longer to get to the gap in Medicare coverage with the generic than if taking Lipitor,” he said.

Watching The Gap

Certain drugs do not have a generic equivalent, said Mr Gubbiotti, and that can be a problem for those with a plan like the Medicare Part D. The coverage gap when Medicare Part D does not pay for the prescription begins when the beneficiary’s drug costs for the year reach $2,400. At that point, they must pay 100 percent of the drug costs until they reach the “catastrophic” phase of $5,451 in drug costs, or a new year begins. Branded prescription drugs can be very expensive and there is a concern that patients who reach the gap in coverage may cease to take the medication when they can no longer afford it.

“We try to help them see that gap coming,” he said. For some, it may mean making use of a pharmacy store plan rather than the Medicare plan to cover some of the less expensive drugs taken. “That leaves room on the Medicare Part D plan for the more expensive drugs and means that they will have coverage for a longer period before they reach that gap,” he explained. He also suggested that clients sit down once a year and review their Medicare Part D plan with the pharmacist to ensure that they have the plan that is best suited to their needs. “In Connecticut, there are over 50 Medicare plans they can select. It can be confusing, but we are happy to go on the computer with patients and take a look at the process,” he said.

Mr Gubbiotti did caution that the quality of generic drugs purchased online can be a bit of a gamble unless it is from a well-known, reliable source. “Drugs are produced all over the world, but they must go through FDA approval to be distributed here,” he said. He feels confident that the generic drugs are a good option in cases where a doctor does not indicate only a branded drug. “They are much less expensive, so there is less chance anyone is going to have to quit taking them, it takes longer to reach that Medicare gap of coverage with generic drugs, and only in very few instances does anyone say that they feel different than when they paid for the branded drug,” Mr Gubbiotti.

“Everyone would love to have the brand name,” said Mr Gubbiotti, “but they are so expensive.”