Older Drugs Can Be Just As Good And Cheaper

Newfangled doesn’t necessarily mean that much better, especially when it comes to taking medicine. Getting prescribed the latest and greatest pill could mean you’re paying more when there’s a perfectly good drug out there that can do the same job, minus the jacked-up new drug patent cost. Vanguard says:

Several recent studies have shown convincingly that older, less expensive drugs work just as well as newer, far more expensive ones. According to a recent report in the Journal of the American Medical Association, a decades-old, inexpensive diuretic does as good a job preventing fatal and non-fatal heart attacks as some newer high blood pressure medications.

Similarly, older medications for illnesses ranging from arthritis to schizophrenia have proven to be as effective as newer, higher-priced drugs.

So, whether you’re already taking a medicine or getting prescribed a new medication, ask your doctor if there are any established, but not as pricey, versions of the drug that you could be taking instead.

Seven ways to cut the cost of medicine [Vanguard] (Photo: Spidra Webster)

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  1. edwardso says:

    The issue I have with statements like these is that people have different body chemisty and can react very differently to medication

    • Ben Popken says:

      @edwardso: That’s why they say ask your doctor.

      • edwardso says:

        @Ben Popken: of course, but how many people are going to say “Oh, no you don’t, I want the older, cheaper one”

        • pop top says:

          @edwardso: If someone is going to ignore advice from their doctor, they were probably going to do it, with or without the Internet telling them to.

        • Ben Popken says:

          @edwardso: The subset of the population that can think for itself and wants to save money.

          • edwardso says:

            @Ben Popken: mostly, and also the subset that diagnoses conditions via webmd

            • floraposte says:

              @edwardso: I think you’re overstating here, and I’m having a hard time imagining what alternative you’re proposing: consumers, never inquire about your medications, and ignore the fact that there are choices? Yes, people can think they know more than they do, but I don’t really think there’s evidence that overall consumers are worse off from knowing that they have this kind of choice.

              • edwardso says:

                @floraposte: I certainly don’t think that taking one doctors opinion as gospel is a great idea in most situations. But to use this site as an example, everytime there is an article on perscription drugs people make comments on what medication you should NEVER use etc. I guess I’m not really suggesting an alternative other than to take the internet advice with a grain of salt

                • floraposte says:

                  @edwardso: I’d expand that to any advice, including doctors’. That’s basic critical thinking, as well as active consumerism.

            • bohemian says:

              @edwardso: WebMD (and other online sources) gets a bad rap. The problem is when people go hypochondriac or don’t bother to check with a doctor to see if their guess is right.

              So far I have caught things doctors couldn’t figure out 3 times by researching medical journals. These were later confirmed to be correct guesses.

          • bohemian says:

            @Ben Popken: I have noticed that most doctors go right to the brand new expensive drug first. Of course these are what the drug reps are pimping and giving perks for prescribing them. Coincidence?

            I have had a few doctors get really annoyed at my asking if certain older medications would be an option or asking how much this spiffy new superdrug costs. If they can give me valid medical reasons why the new one is needed or a better option I will agree to take it. But without a valid medical reason forget it.

            Older drugs seem to have far fewer and less severe side effects too. The idea of paying over $100 in copays for something that will make you grow a 3rd nipple while gambling naked in your sleep is a pretty big hurdle to overcome.

            • Ben Popken says:

              @bohemian: Exactly. I mean, even assuming no nefarious intentions, *recency* is a key factor in what people remember. The drug reps are busy telling the docs about the newest pills and that’s going to influence what drug the doctor thinks of when it comes time to prescribe for that ailment.

        • tbonekatz says:

          @edwardso:
          I did. The blood pressure med that my doctor prescribed for me was not on my insurance company’s formulary list. I was paying $70 for 3 months supply. I checked my insurance company’s website and it listed 2 other drugs that were in the same class that were on the formulary list. So I asked my doctor if we could change. Now I pay $12 for 3 months supply.

        • Coles_Law says:

          @edwardso: I’d say the exact opposite is much more likely-people demanding newer drugs.

        • Eyebrows McGee (now with double the baby!) says:

          @edwardso: Also, all other things being equal (which they never are, but go with me), the doctor is ethically *supposed* to start with the oldest, best-understood drugs that adequately treat your condition first. If your arthritis can be treated with Advil, the doc should be starting there, not with a Cox-2 inhibitor. If your headaches can be managed with tylenol, the doc should start there, not with brand new high-end migraine medication with as-yet undiscovered side effects.

          Few new drugs are true revolutions in treatment that are DRAMATICALLY better than past-generation drugs; most are merely another tool in the arsenal to FIND that right match of drug and body chemistry. While searching for that match, it’s typically safer to start with older, well-understood drugs — which also tend to be less expensive — unless the newest drugs have significant gains in safety or efficacy. (The twin principal is that generally you start with a lower-impact drug and move up to higher-impact ones, which is often, but not always, the same path you’d take starting with an older drug and moving to a newer one.)

          Pregnancy was actually a pretty interesting look at older drugs; since you can’t do drug studies on pregnant women, they’re fairly confined to prescribing “things people have taken since the beginning of modern medicine” and “things we used to dose pregnant women with before we stopped running experiments on them.”

          • Antiks says:

            @Eyebrows McGee (now with more baby!): That’s quite a blanket statement, as there are so many drugs for so many conditions. New psychiatric drugs can be better than older versions. Prozac for example was the first SSRI and it did wonders for many people with depression.

            • Eyebrows McGee (now with double the baby!) says:

              @Antiks: That’s why I didn’t make it as a blanket statement but carefully circumscribed what I was saying. :)

              I said that FEW new drugs were miracles and dramatically better. Not NO new drugs. SSRIs are an excellent example of a dramatic improvement over an older generation of drugs.

          • Trai_Dep says:

            @Eyebrows McGee (now with more baby!): About the only experimenting on pregnant women I’d condone is substituting B&J’s mint chocolate chip when she’s requested chocolate chip cookie dough too often.

        • rbaldwin says:

          @edwardso: @edwardso: People who have done their research and understand the benefits of generic medication will say that.

          I am a Certified Pharmacy Tech and a healthcare admin. Many of the older generic medications are just as effective safer. With newer drugs you don’t have as much research to understand the side-effects and complications that may occur.

          We do know that individuals have different body chemistry and can have different reactions. That is why we stress research and there are many drugs to treat one condition. Chances are one of those will work.

    • ShadowFalls says:

      @edwardso:

      That is why there are so many drugs for the same condition. In some cases, drugs are used for off-label use as well. Over time they can be found to be useful for other things than originally intended.

    • Robobot says:

      @edwardso: Very true! On the other hand, I highly doubt my doctor has my body chemistry in mind when he fills out prescriptions for the latest and greatest thing every time I see him. When my doctor is openly cutting my visits short so his best buddy, Mr. Drug Rep, can take him out to lunch, something is up.

    • Applekid ‚îÄ‚îÄ‚î¨ Ôªø„Éé( „Çú-„Çú„Éé) says:

      @edwardso: I completely agree. I, for instance, can only breathe ammonia in an argon atmosphere. Please don’t prescribe I take two of these with water when I really should take two of those with pressurized liquid methane.

  2. Rectilinear Propagation says:

    Not to mention that they’ve probably found all the potential side effects for something that’s been around for decades.

    Nothing like hearing, “Hmm, I’ve never seen that before”, from a doctor.

    • Transuranic says:

      @Rectilinear Propagation: Exactly. Once something has been around for long enough, its ill effects should be well-known – and any beneficial effects will be supported by more than just one or two studies claiming a small effect.

    • Jonbo298 says:

      @Rectilinear Propagation: I heard that from a surgeon years back on a problem he’d never seen. Intestines got twisted and perforated and he said he’d only seen that in pigs and never in a human. Though I only foudn out after being knocked out (long story short, they thought appendix and was not after running camera into me). Years later, I’m still having complications because of what he did. All because of those magical words “I’ve never seen this before”.

      Good times…good times.

      • Rectilinear Propagation says:

        @Jonbo298: You’re having complications because they thought it was your appendix or because they screwed up with the camera?

        Either way, YIKES!

    • bohemian says:

      @Rectilinear Propagation: There seems to be a trend of putting drugs on the market and then admit to the nasty side effect and damage after the fact. It appears to be intentional.

      • Amish Undercover says:

        @bohemian: It would be nice if all human trials were reported to the FDA by requirement, not just the ones that were “successful” in the eyes of the drug companies. Then maybe we would catch those problems sooner and also identify which drugs actually are improvements over the old ones.

    • ShanghaiLil says:

      @Rectilinear Propagation: A friend of mine once got “Sir, you have a disease formerly found only in cattle.” That’ll put the fear of God in ya!

  3. tard says:

    Drug companies have to demonstrate that their drug provides some benefit beyond that of drugs currently on the market.

    That being said, for many patients these benefits don’t offer any real advantage. For example, a drug company may introduce a drug that only needs to be taken once a day vs. twice or three times per day. For some patients this is important (increased patient compliance), but for many patients, remembering to take a drug three times per day isn’t a problem.

    There is nothing wrong with asking your doctor to try out generic drugs first. For many people the added cost of the new drugs just isn’t justified.

    ‘tard

    • nagumi says:

      @tard: A good example is the drug Fosolan (also known as Fosomax), an osteoperosis med. It’s to be taken once a week, and afterwards you can’t lay down, can’t eat or drink anything but water (in fact, you have to drink a glass of water after taking it) and you have to take it before breakfast and before anything besides water. Screwing up this routine will lead to extreme acid reflux and even esophageal ulcers (!). That, together with the once a week thing, makes for a lot of ‘selective memory’ issues with patients (such as myself). So they came out with a daily version, except now I need to do the half hour thing every day! too much hassle…

      If they could come out with a version without the hassle that I take every day, even if it had LESS efficacy, I’d take it.

    • Anonymous says:

      @tard: In the US, a drug has to be shown to be effective compared to placebo NOT an active comparator. Some countries require that it be compared to a drug already on the market, but not US.

    • zonk7ate9 says:

      @tard: Yes, but considering it cost only $5 for me no matter what drug it is, I’d rather make the insruance company pay more. Especially when I have to be misdaignosed 2 times before a 3rd doctor will finally do a freaking MRI because the insuarnce company is such a cheap ass. Or when you can clearly see my collar bone is broken THROUGH MY SKIN and it takes a 2nd visit to get an x-ray. Those are the only 2 times I’ve used my insurance in my 22 year life. I’m not a hypochondriac look at my damn records; I wouldn’t be here if it didn’t hurt.

    • ShanghaiLil says:

      @tard: Drug companies do NOT have to demonstrate that their drug provides some benefit beyond that of drugs currently on the market. They have to prove that their products are “safe and effective according to adequate and well-controlled clinical trials.” A drug can be substantially worse than other comparable products for the condition, but if it’s better than nothing, FDA has no legislative authority to block its sale.

  4. nagumi says:

    The primary reason for new antipsychotics being developed at such a feverish pace is that many patients don’t have an antipsychotic that works (or works well). Sure, Zyprexa might cost 50 times more, but if thorazine doesn’t work then it’s worth it. Of course, the issue of docs prescribing new meds due to unethical cooperation with drug manufacturers is an important issue, but there are MANY cases of folks with severe psychotic disorders permanently hospitalized or in a so-called permanent halfway house because no med gets them healthy enough for release. Some schizophrenics find a lovely med that works for them over the long term and go to college and get married and have kids and are happy. Some, however, try the 40+ different configurations of modern antipsychotics and never get healthy enough to live even a little independently.

    Of course, the same is true of all psychiatric conditions treated primarily with drugs (manic depressive, major depressive, OCD and other obsessive disorders) but I spoke specifically of schizophrenia because that’s what’s mentioned in the above post.

    If you’re diagnosed with a mental illness, talk to your doctor about first trying some older medications whose patents have expired (making them cheaper) but don’t necessarily rule out taking some of the new generation – I’ve seen some of them do amazing things for formerly untreatable mental illnesses.

    • MaelstromRider says:

      @Robobot: Time to find a new doctor.

      • nagumi says:

        @MaelstromRider: Sure, but remember – even docs can be victims of advertising. A long series of ads and lectures can convince a doc that this new med is amaaaazing. This isn’t unethical on the part of the doc – it’s just human.

    • bohemian says:

      @nagumi: This is why money needs to be going to cures rather than chemical band aids for chronic medical problems.

    • I Love New Jersey says:

      @nagumi: The whole thing is a scam cooked up by big pharma and doctors who aren’t competent enough to handle actual medicine.

    • ShanghaiLil says:

      @nagumi: Another reason that antipsychotics are being developed so rapidly is that they’re the new benzodiazapines — that is to say, they’re often heavily sedating, and thence the drugs of choice for convincing old people in nursing homes to continue sitting in a puddle of their own urine until some underqualified staff person finishing their personal phone conversation and checks on the patient. Also, as my psychiatrist put it, “They’re good for making difficult people be quiet.”

  5. MaelstromRider says:

    The article also mentions generics, which may seem to be a no-brainer, but in some cases there are differences between the medications. For example, with the blood pressure med my fiance is taking, the brand name version is coated so that it doesn’t start dissolving until it’s past the stomach. The generic version doesn’t have that coating, so it starts dissolving in his stomach and makes him very nauseous. The price difference is almost $100.

    • nagumi says:

      @MaelstromRider: technically aren’t those different medications (not just different versions of the same med?)

      • MaelstromRider says:

        @nagumi: Not according to the stupid health insurance formulary. It’s automatically substituted for the brand.

    • floraposte says:

      @MaelstromRider: Plus there’s often not “the” generic, in the sense that it’s just from one company making the generic the way there is the patented drug, and inert ingredients and production processes will vary from company to company.

    • edwardso says:

      @MaelstromRider: That’s such a crappy decision to have to make, The more expensive pill makes you feel better, but the less expensive on is, well, less expensive.

    • Tankueray says:

      @MaelstromRider: IANAD and this is not medical advice. Since the one is uncoated, I’m assuming it can be chopped up safely. Get you a pill splitter or mortar and pestle and grind/or half it and shove it into an empty gel cap you buy at the health food store. They will eventually melt in your mouth, and they do melt pretty quickly in the stomach, but it might help.

      Also, generics are not always the same formulation as the brand name and generics are never the exact formulation of the name brand.

      They are mirror images, like your hands. Once you place your hands flat on the table, you see they are not exactly the same. In chemistry, there are terms for this and (when I was in school) they were referred to as “right-handed” and “left-handed”. I want to say “isomeres”, but that sounds wrong, maybe chirality?

      • morlo says:

        @Tankueray: I’m no chemist, but that last part is nonsense. When the patent expires for a drug it’s a lot easier for generic companies just to duplicate it. It might be a different color, but that also might make it work a little better.

        • Tankueray says:

          @morlo: You’re right. You are no chemist, whereas I have a minor in it. The brands just don’t hand over their recipe to anyone that asks when the patent expires. The generic companies may know what the active ingredients are, but not what the ratios may be. They have to reverse engineer it to create the generic. Chirality is very common, as the original comment in this thread stated. One pill makes her husband sick and the other doesn’t. They are not exactly chemically the same.
          [en.wikipedia.org]
          They only have to be bioequivalent.

          • simplekismet says:

            @Tankueray: Generally, even if you’ve got a racemic mixture (both enantiomers), only one of them is producing the drug activity. The big enantiomer issue comes when the patent is about to run out so the drug company “purifies” develops the drug as a single enantiomer, manages a study with a 1% decrease in adverse reactions or increase in efficacy, and gets a new patent (e.g., omeprazole/esomeprazole, citalopram/escitalopram, floxacin/levofloxacin, loratadine/desloratadine, cetirizine/levocetirizine, etc etc). Most of the time for drugs like these.. the old one works just fine.

            In this situation, the reason one pill makes her husband sick and the other doesn’t is the coating, which may not even be a “coating” but instead a special type of pill. The casing is insoluble in the body and tiny tiny holes are in the casing and when the difference in osmality is correct (i.e., when it hits the intestines) the drug is released. This keeps the drug from being released in the stomach. These types of casings are proprietary so the generic companies come up with their own but maybe don’t work quite as well.

            Also just because the insurance company is substituting a drug does not make it “generic” or “bioequivalent” or “AB rated” or anything. It’s simply the insurance company saying “we’re not paying for drug A, only drug B” and your pharmacy will ask your doctor to change to drug B or fill out a crapload of paperwork to get drug A, and most doctors say “never mind just give them drug B”. So it’s entirely possible hubby is not getting an “inferior generic” but a completely different drug.

            Generics in fact CAN be the EXACT FORMULATION of the brand name. Greenstone is owned by Pfizer. Guess what Greenstone is selling? Pfizer’s drugs. As “generic”. It allows Pfizer to keep market control and keep the price up.

            What usually differs between brand and generic drugs are inert ingredients – fillers, binders, colors. This can react differently with different people’s body chemistries but for 95% of drugs (and in this venue, it bears repeating, since I read people say this every time a generic-drug-article comes up – for 95% of drugs and 95% people) this is not a big deal.

            (Technically, I am not a chemist, but the degree on my wall says “Major in Biochemistry & Molecular Biology” and its soon to be joined by one that says “Doctor of Pharmacy”.)

            • Tankueray says:

              @simplekismet: Wow. You completely missed the point but thank you for your textbook explanation. I know what I meant when I said, “Also, generics are not always the same formulation as the brand name and generics are never the exact formulation of the name brand.” I should have said to be less confusing, “Generics are not always the same formulation of the brand name.” They can be if the brand company has a deal with the generic, as they will hand over the formula. Otherwise, it has to be reverse engineered. And all that has to be in there are the actives, and usually it is all the fillers and binders, etc. that make the difference. There are people that have reactions to one and not the other, 95% are fine, but 5% is still a lot of people. I’ve seen this often with drugs that are manufactured using animals. As cruel as it is, there are people that can’t use a synthetic. (As one is synthetic, it is not the same thing, but usually is referred to as the “generic” version. There can be many explanations as to why that is. [see next point])

              I didn’t mention insurance at all. I am fully aware of their substitution practices.

              I was just trying to clarify that in fact my comments weren’t “nonsense” without transcribing from a textbook and confusing the issue further.

              Congratulations on your degree. Pharmacist is a stable profession.

  6. extremenachos says:

    You have to remember that even if a new drug is expensive, it might still be cost-effective to a major health care payer or provider. Imagine a drug that reduces cholesterol but causes a non-curable but treatable heart condition for 1 out of every 10,000 patients. Then a second company comes out with a newer drug in the same class that has comparable efficacy, but it reduces the frequency of the heart disease side effect to 1 in 100,000 or even removes the risk. Even though the drug is far more expensive, not having to treat for the heart disease might be cheaper in the long run.

    • speedwell (propagandist and secular snarkist) says:

      @extremenachos: Exactly so…

      I think I know what older drug they’re talking about when they refer to “a decades-old, inexpensive diuretic [that] does as good a job preventing fatal and non-fatal heart attacks as some newer high blood pressure medications.”

      A few years ago, I had kidney problems. I was prescribed a thiazide diuretic, hydrochlorothiazide, that is also used as a blood pressure medication. Last year, with no warning at all, I was diagnosed with diabetes. While researching causes of and approaches to diabetes, I read that thiazide diuretics have been known to actually cause diabetes. (Woo-hoo. Where’s my class action lawsuit?)

      I’m now on a different, newer blood pressure medication that doesn’t have the same side effects.

      • Rectilinear Propagation says:

        Last year, with no warning at all, I was diagnosed with diabetes.

        @speedwell, avatar of snark: My mom was watching something (she didn’t say what) and a doctor was saying that the rise in diabetes was alarming and he blamed HFCS.

        The thing is not everyone getting it is overweight. Professional athletes (current too, not retired) have been diagnosed with it.

  7. EllaMcWho says:

    Exactly why my MD prescribes LEVORA, 21 day supply X 3 refills, @$8 copay rather than SEASONIQUE, 90 day supply X 1 refill, @ $145 copay. Older drug, similar formulary = BIG savings for me.

  8. qxrt says:

    That Owl Rexall Drugs store in the post photo looks just like the one near my apartment back when I lived in Berkeley. Hmm…couldn’t be the same one, could it?

  9. Antiks says:

    Big Pharm should NOT be allowed to advertise directly to consumers. This is part of the problem. A lot of patients walk into the Dr.’s office saying they want X drug because they saw it in a commercial. The Dr. should be a final arbiter to see who get what drug, not the patient.

    • annexw says:

      @Antiks:
      But only a Doctor can write a script, so they still are the final arbiter.

      I see where you are coming from, but its still the doc’s choice.

    • Ratty says:

      @Antiks: A lot of those commercials also advertise new drugs for conditions that may have not been easily treated previously. i agree that they probably market too heavily, but someone still needs to see a doctor and discuss it before they can get a prescription.

    • H3ion says:

      @Antiks: Actually, I prefer that the drug be determined by the doctor and patient in consultation with each other. That’s why I always check the PDR when the doc wants to give me something different. They’re human too, they make mistakes, and I’d rather not have the adverse reaction.

    • ShanghaiLil says:

      @Antiks: I’m curious — DO patients “walk into the Dr.’s office saying they want X drug?” I suspect that with lifestyle drugs, such as Levitra and Cialis, patients may be influenced by advertising, but with treatments for serious illnesses, I hope — perhaps with excessive optimism — that noone with half a brain shapes important treatment decisions around a poster that they saw in the subway. And if they do? shaking head Darwin’s Law applies.

  10. Jessica O'Dowd says:

    Many older drugs, have worse adverse effects. Older anti psychotics work just as well as the new ones, but have more adverse effects,with some that can stay after you are done the med. So would you rather take a med that would help you get better, that is cheaper, but has horrible side effects that could possible never go away? I’d rather pay more..

    • H3ion says:

      @Jessica O’Dowd: That’s not always true. Some of the older formulations had no or very limited side effects or interactions while the newer ones can make you glow in the dark. You have to check it every time. And sometimes the side effects don’t show up for a while. Does anyone recall Thalidomide?

    • I Love New Jersey says:

      @Antiks: And of course the doctors get all sorts of stuff from big pharma, too.

      • ShanghaiLil says:

        @I Love New Jersey: Newer drugs also almost universally have fewer clinical data supporting their use — the older drugs appear to have more side effects because we know the full range of side effects associated with their use, whereas with a new drug we are usually only looking at the most frequent and serious side effects. How many years was Merck able to stall release of the news that Vioxx caused heart attacks?

  11. edesignway says:

    I got pretty sick over a few weekends ago and ended up going into an urgent care place since my regular doc was off. The doc I saw at the urgent care place was very much old school (he was in his 60’s or 70’s). He talked about this during the exam saying how he doesn’t understand why all of these younger docs have to prescribe only the newest medications. He said if they’ve been around for 20 or 30 years there is a reason. He prescribed me an “older” medication, not only was it $4 at the pharmacy, but it did the trick in short order.

  12. edesignway says:

    .

  13. I Love New Jersey says:

    Newer more expensive ones tend to have large marketing campaigns behind them. Older drugs tend to have more real world experience.

  14. notanignoramus says:

    I can see both sides of this story. Lexapro is a “purified” version of Celexa, which is the older drug. The company found out that only one of the two configurations of the active ingredient (s-citalopram or “escitalopram” was the active rather than d-citalopram) and therefore has been able to market Lexapro as twice as potent as Celexa. Now Celexa is on the $4 list at Wal-Mart and if I wanted to, I could save money by taking it. BUT – I had a lot of side effects from Celexa that disappeared when I started taking Lexapro. Perhaps Celexa had more lactose in the binder, or my body just didn’t like d-citalopram – I don’t know. What I do know is that even though I take an experimentally high dose of Lexapro, I don’t have the muscle aches and paresthesias (abnormal sensations) that I had with Celexa.
    Drug company marketing, desperate patients, patients who don’t recognize what “normal” is, doctors who are tired of saying “no” to those patients, doctors who are uninformed or overinformed to the point of near-brainwashing – these are all problems with our health care system in general. Despite my personal illnesses, I have taken lots of time to educate myself about each medication I am prescribed (including antibiotics and vitamin supplements) and I have questioned my physicians in the past about their recommendations.
    However, despite rampant overmarketing and overzealous consumerism, there ARE people who have a legitimate NEED for newer medications. I have read scathing reviews and heard nasty whispers about Detrol, but I also know several people who used to feel confined by their problems with incontinence who have had a clear improvement in their quality of life. They can now participate more readily in social activities, and go about necessary daily routines with more freedom – with a concurrent improvement in mood and overall physical health as a result of the new-found freedom from symptoms.

  15. chemicalx9 says:

    Generic drugs FTW!