Generics vs. brand: Efficacy, risk called into question

Dermatologists use a variety of medications to treat common ailments.

Topical steroids, antibiotics and antifungals are among the most common categories. But are the medications doing the job doctors - and patients - expect them to do without creating unnecessary risks?

On Call asked a number of dermatologists around the country if they have a choice between brand name medications and generics, does it matter to them which they prescribe and, if so, why?

Most prescribe mixture

Most of the doctors say they prescribe a mixture of medications - both generic and brand name - but most also take issue with the concept that generics are always equivalent to their brand-name counterparts.

Often doctors will prescribe the generic version of a drug for insurance reasons.

Valerie N. Hanft, M.D., Austin, Texas, says patients will generally tell her if insurance creates a problem for them.

"If there's a $50 co-pay for the brand name and just $10 for the generic, they are usually quite willing to share that information with me - and that would determine generic.

"Sometimes, I actually get callbacks from a patient who I've written for a branded product with a request to substitute it. I generally assume that's co-pay related."

In Quincy, Ill., William J. Hanshaw, M.D., says, "I prescribe both, but I prescribe generics because insurance companies dictate it. You have to use them if you want to get any medicines out of the insurance and you have a lot of trouble with Medicare/Medicaid where they automatically want to switch prescription medications into generics or they may not be covered."

But that doesn't mean he would prefer generics.

"I probably prefer the brand names - more information is available on them. They need to meet more criteria to get the drug to the market, and you know where they are coming from. Generics are not as rigorously controlled as well as the brand names.

"The effectiveness isn't always the same, either," he says. "Sometimes you can have a 10 percent to 15 percent deviation. You have to forewarn patients that the medicine may not be as good."

Antifungals

One example that insurance companies limit, according to Dr. Hanshaw, is the antifungal medication category.

"The three effective antifungals are brand names," he says.

James P. Harnisch, M.D, a practitioner for 29 years, in Bellevue, Wash., says he sees enough difference between generics and name brands to try to use the brand names if possible.

"I'll choose brand names on topical steroids when I need to avoid potential irritant effects."