Caregivers spend a lot of time making important decisions with – and for – their darlings that may have great or little impact. For me, it’s difficult to assess whether a decision we are contemplating is the right one, which is why I rely on the experts around me who are intimately aware of our situation, and the potential pitfalls of a well-intentioned decision gone wrong.

A recent situation – a situation that I had been hoping for – recently threw me for a loop. My darling takes several prescription medications to help preserve quality of life and to help prevent progression – one of the daily medications is a brand drug. Even with insurance, the medication is very expensive – it’s considered a “Tier 2” drug according to our formulary (a list of medications that insurance will cover, and it’s prioritized by cost to the patient.)

For 5 years, I have asked our pharmacist – “WHEN is this drug going to go generic?” – and her response has always been – “As soon as it does, I’m going to let you know.”

Well, it finally happened. I called to refill the prescription and our pharmacist informed me that there was (finally) a generic of this medication and did I want to fill it? The cost would be one-third of what we have been paying for the last five years.

And instead of immediately agreeing to the switch – I paused.

According to the FDA, the active ingredients in generic drugs are exactly the same as the ones in the brand form of the drug. This piece of information gives me a lot of comfort. However, the inactive ingredients in a generic drug may not be exactly the same as the brand drug. And while these are inactive ingredients that aren’t supposed to impede the therapeutic efficacy of a medication, was it possible that it could? I didn’t have a good answer to this question.

So, how was I going to manage this situation to help protect against a potentially negative impact?

• Talk to a trusted pharmacist. Our pharmacist has been caring for our family for the better part of five years. I trust her and she has always (and I mean ALWAYS) done her best to answer my questions, even the crazy ones, and help me problem solve issues that have come up. The two questions I asked were:
  1. How many other patients have tried this medication?
  2. How many of those patients have had to refill the previous prescription for the brand drug because the generic didn’t work for them?

                The answers were – a couple handfuls of patients; and nobody.

• Purchase the generic without engaging insurance. Our pharmacist understood my concerns about introducing a new generic medication with the possibility of new inactive ingredients. She suggested that we purchase the smallest prescription available (30 days) and that we pay cash for it ($20) so that if he tried this new drug and had an adverse reaction, we could easily engage insurance to purchase the brand drug.

• Work with the pharmacist to determine an appropriate “test” period. Unless a severe reaction occurs, it may take a few days to really determine if a medication is working or not. Our pharmacist, on a number of occasions, has suggested that a seven-day period may be enough time to determine if something is working or not. This may or may not be the case for all medications, but in this instance we tested the medications for seven days. Talk to your pharmacist and determine and appropriate length of time together.

This story has a happy ending, in that the generic medication worked as well as the brand drug – but we were prepared to switch back to brand if it didn’t.  

If you’re interested in learning about how to reduce prescription drug costs, read: 4 Ways that May Help Reduce Prescription Drug Costs.