[kemiller2002]

It's because a lot of times the doctors know it isn't going to work on the outset. A number of generics don't work exactly the same. You're punishing the patient and questioning the expert simply for the fact that the insurance company (or the government in the case of geriatrics) might save a few dollars.

[AuthorizedCust]

That’s exaggerated. Generics are well known to be effective, and exceptions are unusual. Here’s some commentary to that effect, talking about research to the contrary: https://www.health.harvard.edu/staying-healthy/do-generic-dr...

It’s reasonable to expect people to exhaust lower cost alternatives, that are reasonably expected to work, before stepping up costs.

[SamoyedFurFluff]

Part of the issue is that insurance companies often “reset” this process. I know a friend with really hyper specific health conditions that requires a fairly expensive, experimental treatment. They need this because they’ve tried everything already. But sometimes the insurance company seems to forget that they already tried everything, and refuses to pay and tries to get them to go through it all over again, a process which destroys their ability to function and leaves them seriously disabled for months at a time.

This also happens if the employer switches insurance.

So no it isn’t as innocent not as simple as saving costs for generics. This makes sense for the first time the patient seeks treatment. This doesn’t make sense if the patient already has a treatment plan that works and the insurance company decides they want to do the whole pony show again, fucking in peoples life for months.

[text70]

Speaking of genetics, screening for the genetic profile of variable liver enzymes for known mutations and their associated drug interactions could actually save on the shotgun approach to dispensing medicines.

The problem is, you won't be able to hammer down the health of the patient to the lowest cost option, only the most effective.

[AuthorizedCust]

Ha! My keyboard autocorrected generics to genetics! Fixed in the original comment.

[kemiller2002]

My bad. You are correct. I misspoke. What I meant to say that at times generics (and similar drugs, but not generics) won't work as well as the original drug. Not always, but sometimes they just aren't effective in certain circumstances. The doctor may know this, but can't immediately prescribe what is effective in the name of "saving money"

[rootusrootus]

> Generics are well known to be effective, and exceptions are unusual.

A [relatively] well known exception is anticonvulsants. My younger brother paid for that with his life. I hope the FDA figures out how to properly evaluate generic equivalence.

[Auracle]

It can also just be a matter of convenience. When I was first put on testosterone I was prescribed AndroGel, which is a gel you out on once daily. It costs $400 a month. Insurance gave a bit of hassle but with my test numbers they acquiesced.

They shouldn’t have, though. Injections (what I’m on now) work better. They’re easier to maintain the correct dose, you don’t have to worry about getting it on your partner/kids, you only take it once every week or two…and it’s maybe $20 a month.

That’s not just a few dollars saved. There are probably hundreds of thousands of men out there that take it. I see there’s a generic gel now but it still costs anywhere from $60-$150 a month.

[Auracle]

As I was looking up current AndroGel prices I discovered there’s now a twice daily pill. That’s even more convenient than a gel!

Too bad it’s $1,000 a month. We’re all paying that so people can avoid sticking themselves with a needle.

[makomk]

Thousands of dollars per patient times many different patients and drugs quickly adds up to a substantial proportion of all healthcare spending. Countries with universal healthcare have specific programs in place to move people over to generic drugs for exactly this reason, or at least the UK does - along with policies that intentionally give people less effective treatments if the better ones are a lot more expensive. It's one of the ways they stop costs from ballooning as much as they have in the USA.

[katbyte]

Bc Canada it just covers the equivalent generic cost, if you want to get brand you pay the difference, can be 5$, can be 50$

[refurb]

No, sorry “the doctor knows it won’t work” is complete BS.

We don’t spend 100x on a drug because a doctor “has a feeling”.

The insurance requirements are typically quite limited for 1st line failures. Doctor just needs to prescribe then 2 weeks later attest that it didn’t work.

Seems reasonable to save the healthcare system thousands of dollars when tens of dollars would do?

[civilized]

Which doctors know? Insurers have doctors too, that's why they have these rules. What do the doctors treating the patient know that the insurers don't know or are refusing to acknowledge?

[Dma54rhs]

Well at least in Europe pharmacists always tell you about generics, that they are cheaper and work the same. Not sure who is spreading misinformation here.

Maybe you're talking about different medicines that people are using (like different insulins), the generics use the same formula as the original.