Antiepileptic Drugs: Generic vs. Brand Name

There has been a lot of uproar from epilepsy advocacy groups and foundations over the last year amidst of all of the news about generic and brand name AEDs.

A few months ago, the NHS in the United Kingdom announced the plan (2009 Pharmaceutical Price Regulation Scheme) to make it a requirement for pharmacists to prescribe generic drugs if they are available. This can be a hazardous decision because there are classes of drugs that physicians prefer not prescribe generics such as AEDs.

UK-based groups like Headway and the Joint Epilepsy Council are standing by their position “that only a doctor with special interest in epilepsy should change someone's epilepsy medication, not a pharmacist or health economist.”

In light of this situation, the Joint Epilepsy Council started an e-petition to exempt epilepsy from “the new generic prescribing proposals, on the grounds that the active ingredients in different brands of anti-epileptic medication can legally vary by up to 45%.” http://petitions.number10.gov.uk/epilepsygenerics/#detail By requiring pharmacists to prescribe generic drugs to people with epilepsy, it could lead to breakthrough seizures, loss of driving privileges, or serious injury.

Although it’s not a requirement in the US for pharmacists to provide generic drugs, they are legally allowed to switch (“therapeutic substitution”) a brand name drug with a generic drug without telling the patient or doctor. Typically the pharmacist switches the brand name drug to a generic drug of the exact same medication. However, if the “drug is in the same class as the old and treats the same condition… it's not precisely the same medication.” One way to avoid such a problem is to have the doctor write “brand name is required.”

If healthcare reform legislation is passed, you have to wonder how much pressure doctors will be under to prescribe patients generic drugs even if they believe it’s not in the best interests of the patient. Yes, generic drugs are less expensive, but is it worth taking a chance on a patient’s well-being?