Many patients express concern over the cost of prescription medications. Many heart attack patients, for example, are discharged on 5 or 6 new medications, which are all very expensive. In many cases, generic alternatives are available. There is no evidence to support the thought that generic drugs are inferior to brand-name drugs. When selecting medications as a physician, it is important to choose medications with evidence that they improve the outcome of patients with the condition being treated. In the case of cardiovascular diseases, many of the agents have been studied and shown to be beneficial are now generic. Nonetheless, many pharmaceutical companies are looking for ways to combine generic medications with the newest medications that are still full price. Below are a few examples of well-known medications that are proven to work and are now generic, and the higher-cost alternatives that may be offered.
What to Look for
Carvedilol and Coreg
Carvedilol is a beta blocker that has been proven to reduce mortality in heart failure and is beneficial after heat attack to prevent dangerous irregular heart beats. Coreg went generic in 2007, at the same time Coreg CR was introduced. The newer Coreg CR only requires a single dose each day, while Carvedilol requires two daily dosages. The manufacturer claims that the newer version will provide a sustained release of the beta blocker over 24 hours and is therefore considered more efficacious. Unfortunately, this has not been proven yet in a direct comparison.
Simvastatin and Zocor
Simvastatin is proven to reduce recurrent heart attack, stroke and vascular death in patients who have had a heart attack. When this medication went generic, the answer was Vytorin, which combined Simvastatin with Ezetimibe. This recently embattled drug was wildly successful for several years before evidence emerged that it did not reduce carotid artery plaque thickness in patients at high risk for atherosclerosis. In many cases, Simvastatin alone is sufficient but requires doses of 40 to 80 mg to be effective. If patients can't make their set goal of a lowered cholesterol level at the maximum dose, Vytorin is a good choice.
Norvasc and Amlodipine
Norvasc is a very successful calcium channel blocker that reduces blood pressure and has some properties in reducing chest pains. When it went generic, the industry answer was to create a new combo-pill which includes Norvasc and the very popular cholesterol medication Lipitor. There is no evidence to support that this combo is more effective than either medication alone, but it is suspected that compliance will be better because now you only have to take one pill instead of two. This alternative combo pill is approximately $100 to $150, depending on the dose. The two medications separately are not necessarily cheaper if purchased as the brand name Norvasc and Lipitor.
Common Pitfalls
In many cases, generic medications actually have evidence to support their use. There is no reason to think that generic versions of medications are less effective. Many insurance companies will offer better coverage for a generic version of a cardiac medication. When your physician offers you a new version of a medication, challenge her to give you a reason why this version is more suitable.
