Prescription drug switching is nothing new. We all know generic drugs cost less than brand-name drugs.

But do they work just as well? The answer is complicated. Some do. Some don't.

In an attempt to cut prescription drug costs, experts say some insurers and pharmacies are pressuring doctors to switch stable patients from their current medications to cheaper alternatives.

Sometimes, that's a generic version of the prescribed medication, or it can be a switch to a different medication entirely. In other cases it could be from newer versions of a drug to an older version.

Ajay Mayor, M.D., a Marion-based child and adolescent psychiatrist who practices at Illinois Centre Behavioral Health, has an interesting story to narrate.

Sometime ago, the mother of a child he was treating came back to him saying her child was acting up again, despite being on an antipsychotic drug for a specific psychiatric condition.

"That's when I realized the national pharmaceutical chain she had gone to had switched the prescribed Risperdal with generic Risperdone," Mayor says. "This despite my prescription stating, 'May not substitute.' Given that my patient wasn't responding well to Risperdone, we switched back to Risperdal. Luckily, we managed to get a grant to help support some of the cost, because the parent couldn't afford it," Mayor says.

Since that time, the FDA has approved a generic form of Risperdal.

Recently, four national mental health organizations issued a joint statement about the practice of therapeutic substitution. The American Psychiatric Association, Mental Health America, the National Alliance for the Mentally Ill and the National Council for Community Behavioral Healthcare released a statement advising that the substitution of one medication for another based purely on cost should not be done with mental illnesses, especially because the needs of each patient are so unique, and the delicate balance of medications is so difficult to achieve.

Ben Calcaterra, a registered pharmacist at Logan Primary Pharmacy in Herrin, is also the Region 12 director of the Illinois Pharmacist Association. He said insurance companies have traditionally had formularies, which are lists of pharmaceutical substances along with their formulas, uses and methods of preparation, that may or may not be covered in an insurance plan.

"If you come in with a new brand-name drug that is not in the formulary, you end up paying full price," Calcaterra says. "If you buy a drug listed in the formulary, you only pay your co-pay; your insurance picks up the rest."

"Prescription drug switching should only be done when both the pharmacist and the doctor agree that it is to the benefit of the patient," Calcaterra says. "Also, the patient should be aware of the switch and be OK with it. The doctor makes the final decision."

Calcaterra notes that about 80 to 90 percent of the time, a drug that is switched to a generic or different alternative entirely gives similar outcomes to the originally prescribed drug.

Calcaterra also notes that the higher-priced drug is not necessarily the best drug.

"To turn the question around, why are brand-name drugs being prescribed when there are cheaper alternatives that work just as well?" Calcaterra says.

"Take Lipitor, a cholesterol drug, for example. There are several generic drugs on the market that cost pennies a day, instead of dollars a day, providing the same results. So why not switch to a generic instead?"

However, Calcaterra admits that in some cases, in mental health especially, the originally prescribed drug may well be the best drug to take for a specific condition.

poornima.jayaraman@thesouthern.com

351-5019

Avoiding the pitfalls of therapeutic switching

There are several things you can do to protect your health if being switched to a generic medication.

Ben Calcaterra, a registered pharmacist at Logan Primary Pharmacy in Herrin, says it's important to have a detailed conversation with your doctor and a pharmacist you trust. Ask for their best recommendation for your particular situation, regardless of cost and your insurance coverage. Make sure you know what your choices are and what is best for your health.

Ajay Mayor, M.D., a child and adolescent psychiatrist at Illinois Centre Behavioral Health in Marion, has the following advice:

l Read labels of all medications you pick up at the pharmacy. If it doesn't seem like the same medication you are used to taking, ask the pharmacist why it has changed.

l Take all your medication with you for doctor visits. Show it to your doctor, so he or she can confirm it's the right medication you are supposed to be taking.

l If you are on the same medication, but feel your symptoms are changing, recheck your medication. Go back to the pharmacy and physician and find out why.

l If you are not getting better, it helps to go to a specialist. If you cannot afford a particular drug and your insurance won't cover it, a specialist may be able to get you free samples or point you in the direction of a prescription-assistance program or grant.

- Poornima Jayaraman