If generics are as effective as brand, why is the option for "Do Not Substitute" on the prescription form?

Question

Without starting an argument about whether or not generic medications are equal in the active ingredient(s) -- as they are legally supposed to be under US law.....

Let's assume that they are the same (or if they aren't, please only post a comment if you have some really firm evidence that says otherwise, other than 'it just feels different' since that can be from a placebo or other effect) for the sake of this question:

If they are the same, why does the doctor have the option of marking "Do Not Substitute" on each prescription form that you give to the pharmacist? For a very small number of people, maybe an inactive filler might have an allergic reaction to someone, but I wouldn't think that's common enough to have a checkbox on every form.

Is there a good way to explain what this would be used for? Thanks!

Answer 1

Though the active contents indicated in both the generic and a brand are the same, the effectiveness are not always the same. I had proven that throughout my practice.

Some response to a generic are sometimes weak or slow and some brand appear to be more effective. To cite an example, a generic paracetamol lowers the temperature of a certain patient very slowly while a brand paracetamol has very quick action when given to the same patient.

The doctor's experience could had driven him to mark "Do Not Substitute" in his prescription based on evidences he got with his prescribed medications.

Answer 2

Greydoc is correct to a point. Now we have the capability to flavor almost any liquid to the patients personal taste. Few people know that most of the major generic manufacturers are actually ownes by a brand name company. That way the parent company makes a profit for either the brand or generic and the patient receives the same quality control at a reduced price. For some strange reason, the only class of physicians still insisting on brand medication are dermatologists. I guess that acne medicine is more important then heart medication since cardiologists never insist on brands.

In Texas, for a prescription to be filled with a brand, the physician must write in his handwriting "brand name medically necessary". No check boxes, rubber stamps or preprinted brand only prescriptions are allowed.

Answer 3

Sometimes there are reports that a generic is not as effective as the original brand. This was briefly the case with long acting methylphenidate (Ritalin) about a decade ago. Also, in those instances, insurance may not cover the brand name unless "Do Not Substitute" is on the prescription.

In pediatrics, there was another reason. Some liquid preparations for small children taste terrible, and most children refuse to take them. It is no savings if the medicine is not consumed. So we order a better tasting preparation and put "Do not substitute" on the prescription.

As far as a checkbox on each blank, it just saves time.

Answer 4

There are two things that I can think of..
Firsty, some doctors are quite old fashioned and prefer not to prescribe generics simply because they're used to the original brand and trust the product.
Secondly, if people are taking alot of different medications or are elderly they may get confused about which medications they're taking if they're supplied with generics
Those are just my thoughts, I'm sure there are other reasons.