The Game of Generics – Are All Medications Created Equal?

Ethos Ho, BSc Pharm Candidate

The Generic Question

You’ve probably heard your healthcare provider tell you that brand name medications are more or less the same as generics. You may have seen the names APO-, PMS-, or TEVA on the labels you get from the pharmacy – these are the abbreviations of different generic drug companies. But have you ever wondered if these generic “copies” are truly equal to the brand version? Is the brand name version really the king of all drugs in terms of quality and safety? And why are generic drugs are so much cheaper in the first place?

Once Upon a Time, the Innovator Ruled the Market….

Let’s start with what a brand name medication is. It’s the original, and first-of-its-kind, made by a drug company after spending extensive resources and money on research and testing. Brand name medications are often called innovator drugs, as they’re truly new and original on the market. When brand-name medications first come out, they’re protected under a patent, a government license that allows the brand name to exist in the market without competition for a set period (usually 20 years).¹ Because brand-name companies have spent so much money on research, and have only short time to make their money back, brand-name drugs are sold at a higher price.

Once a patent expires, generic companies are given the information to create the medication themselves. Since generic companies never had to spend the money on research and development, and have to compete with each other, generic prices are lower.²

Are Generics Truly Equal?

Unlike with brand name medications, it’s easier for generics to enter the market since all of the research and testing has already been done. For generic companies, their version of the medication must meet the following requirements:²

• Absorbs into our bodies the same way as the brand name version
• Reaches similar concentrations (levels) in the blood as the brand name 

If a generic medication meets these requirements, they are termed bioequivalent (equal) and are considered to be as effective as the brand name.²

But how well does this work out for real-life patients?

Studies comparing the differences and outcomes in people that have used generics over brand name have shown that these drugs are in fact interchangeable.^3,4 Meaning, we can be confident that generic medications will produce the same effect as their brand name equivalents, with the additional benefit of saving money. Of course, skepticism still exists among some patients who believe that differences do exist between brand and generic, which may be true to some extent.

How Are They Different?

There are differences in the inactive ingredients, cost, and sometimes the appearance of generics since regulations only apply to medicinal ingredient(s).² Also, as we’ve mentioned before, generics have to reach similar concentrations in human blood as the original version. However, small variations are acceptable for generics as long as they stay within a narrow range.² These variations can potentially make a difference for highly sensitive individuals, or for medications that require a precise dose to work properly. These can include:³

• Seizure medications
• Blood thinners (e.g. Warfarin)
• Transplant medications

In the end, though, the evidence that these variations make a difference is few and far between, mainly coming from a few, isolated case reports.³ The overall evidence we have is still that generics work just the same as the brand name.

The Bottom Line

Generic medications are effective, cheaper substitutions for their brand name counterparts based on many studies and patient experiences. There is a small chance that differences may exist for certain medications and individuals, but overall, generic medications are considered equal.

So what should you do? If you’ve been on a brand name medication for a long time with no issues, there’s nothing wrong with staying on it. The saying “if it’s not broke, don’t fix it” holds true. However, if the cost of your medication has ever been a problem, consider asking your healthcare provider about switching to generic.   

As always, we hope you learned something new from this article. If you have any questions or concerns, reach out to us through Instagram, Facebook, or at ask@orbishealth.ca, and we would be more than happy to answer you.

RESOURCES

1. http://www.ic.gc.ca/eic/site/cipointernet-internetopic.nsf/eng/wr03716.html
2. https://www.cadth.ca/generic-drugs/similarities-and-differences-between-brand-name-and-generic-drugs
3. Kesselheim, A. (2011). The backlash against bioequivalence and the interchangeability of brand-name and generic drugs. Canadian Medical Association Journal, 183(12), 1350-1351.
4. Manzoli, L., Flacco, M., Boccia, S., D’Andrea, E., Panic, N., & Marzuillo, C. et al. (2015). Generic versus brand-name drugs used in cardiovascular diseases. European Journal Of Epidemiology, 31(4), 351-368. http://dx.doi.org/10.1007/s10654-015-0104-8