Medicines we take exist in two forms, they may either be Branded or Generic. We may have wondered why we keep coming across different colors and shapes of tablets and capsules, yet we are told it’s the same drug. This should not confuse us because whilst the pills we receive at the pharmacy counter may look slightly different they have the same effect. They have the same active ingredients, although some are termed generic while others are branded drugs. We need to emphasize that both branded and generic medicines have the same quality, strength, safety, dosage and route of administration (termed pharmaceutical equivalence).
In essence, the difference between branded and generic drugs is in the circumstances of producing the drugs. While brand name drug refers to the name given by the producing (innovator) company, generic drug refers to a drug named after the active ingredient or the molecule.
An example is the brand name Fansidar produced by Roche pharmaceuticals has active ingredient Sulphadoxine Pyrimethamine (SP) which is also its generic name.
An active ingredient e.g. SP is the component of a medication that's responsible for its medical or therapeutic effects. In addition to providing a healing effect, an active ingredient can also cause adverse or unintended effects that could cause mild discomfort, or worse. Medicines are given on the assumption that the benefits realized outweigh the side effects and that the side effects can be tolerable.
Inactive ingredients, which are also called excipients, are the components that do not have a healing effect on you, but then they are included in medication as binders, fillers, flavourings, coatings, dyes preservatives etc.. Some drugs would have been too tiny to take in the recommended doses for example 1 microgram of the drug digoxin or thyroxine. The commercial sachet of salt at the restaurants is usually 1g and one microgram would be one millionth of that weight, so to make the drug touchable the manufacturers have to bulk it up to a bigger size by using fillers. The difference between generic and branded medicines therefore lies in the composition of its inactive ingredients hence can have different colors, shapes, etc. As in brand name drugs they have its unique brand name and composition. Due to trademark laws, generic and brand-name medications are not supposed to look the same. In many cases, the name of the generic drug will be the same as the active ingredient.
This is done to protect the brand image ( trademark) which has some cost implication and is properly guarded by medicine control bodies such as the Food and Drug association in America and the Pharmacy and Medicines Regulatory Authority in Malawi. It takes decade years of research for the innovator company to bring the new drug to market. To recoup these costs, in USA the FDA gives the company patent rights usually 20 years after which other companies are permitted to replicate the molecule exactly. This is the reason why branded medicines have higher prices than their generic equivalent because the generic manufacturers did not sweat it out intellectually or entrepreneurially. But the FDA rules are very strict that the generic should be exactly the same as the original drug in terms of the active ingredient properties, effectiveness (termed bioequivalence), bio-availability and safety profile otherwise they would not approve.
There is a third category in India where patent rules are loose, and the drugs are termed branded generics. This only means that these are copies of the original but modified differently in excipients according to manufacturer. But they are not owners of the intellectual property.
Unlike brand companies, generic manufacturers compete directly on price, resulting in lower prices for consumers. As such the information on brands and generics is crucial to all patients to know.
In some countries, health insurance companies do not cover branded medicines especially in chronic conditions while others cover them only up to the equivalent of the generic price and patients pay the difference out of pocket. The differences between generic and branded prices are noticed more when people are taking chronic drugs for ongoing conditions. For pure reasons of continuity, generics for chronic conditions have proven to be more effective than branded because the branded chronic drugs are more likely to be skipped due to costs to patients.
Chronic conditions are ongoing conditions whereby people must take medicines continuously for over three months and many are for lifetime. Some medical insurance companies do not even cover chronic medicines. Suffice to say generics have saved Americans a lot of money through awareness done to the public on both generics and brands. 90% of prescribed medicines in America are generics while that figure for MASM is around 70%.
We observe that in the developing countries the difference in price is so remarkable as much as 10 times between branded and generics. MASM just like other medical Aid Funders, encourages our service providers and members to prescribe and use generics and only switch to branded where circumstances do not permit.
There are however some cases where you should stay on a brand-name medication or use it over a generic one and they include:
When there is no generic version available. E.g., Premarin
When you take a narrow therapeutic index drug. These are drugs where small differences in the dose or blood concentration of the medication can lead to serious reactions. e.g., Digoxin. Dosing slightly lower would result in the drug not being effective and slight overdose will result is serious side effects
When you don’t do as well on the generic. Very rarely, people respond poorly when they switch to a generic. Like in some cases of chronic drugs.
When you experience allergic reactions or intolerances to the Inactive ingredients used in the formulation of generic drugs.
When such is the case in the above scenarios, the prescribing doctor usually adds: “Do not Substitute” or “dispense as written”
In a survey it was found that 11% of doctors had a negative view of generic drugs (thought less effective) while the figure was 2.3% for pharmacists. This can be explained by the fact pharmacists have more experience with the drug intricacies than doctors who are usually approached during marketing. There were also placebo studies whereby a generic was packaged in a branded label and the recipients felt better than when the same drug was packaged in its generic packaging. Such is the power of marketing.
In summary, branded drug in the strict sense of the word refers to the version of the drug by the inventor which underwent different trails but is expensive until the company recoups its expenses afterwhich the same drug becomes cheaper or is permitted to other companies to copy manufacturer in its scientific name (generic -USA) or various generic flavours (branded generic – India). Strict and rigorous laws means that generics are manufactured 100% specific to the active ingredient of the branded and as such only differ in choice of fillers and price. Only in very rare occasions branded medicines cannot be substituted.
This piece of advice is very important in terms of affordability of treatment to patients that they access in hospitals and pharmacies. Many people are thrown into health-related poverty because of failure to make decisions related to general healthcare and medications.
This presentation will help our members to look again on usual medicines that they take and start making decisions in consultation with their doctors on which brands and combinations can be changed to realize savings on various limits of allocation or benefits while not compromising quality of care.
