Is there any reason why a doctor wouldn't give me separate medications for this?

Factual Questions
1

So I’ve been dealing with stomach crap for the last (almost) three months. I’ve been on various combinations of PPIs and acid reducers, all while my pharmacists told me it was an ulcer (two different doctors told me it was just reflux). So when my stomach started bleeding, the doctor sent me for an H. pylori test, and it came back positive. So she called in a Prevpac for me, which after insurance is $75. The three medicines separately, though, are going to be considerably less (the Biaxin and amoxicillin, especially). But she doesn’t want to give them to me separately? Is there any reason for this? She shouldn’t be worried about compliance, I’m a normal-memoried 21 year old!

My guess is that the drug reps have gotten to her, because she mentioned that “this combination is the most proven effective combination”. What gives?

2

Ugh. GQ please. :rolleyes:

3

Reported.

4

Are the dosages of each drug the same as what you can buy them in indivudally?

The doctor could just be dumb. My doctor told me to take Benadryl for a rash I had and was absolutly convinced that I’m better off taking Benadrly then Nytol (I was taking it becuase it was cheaper then Benadryl). Even after I explained to him that they are the same drug and the same dosage he still insisted on Benadryl. :rolleyes:

5

There’s no good therapeutic reason that I could come across that would indicate any less favorable outcome from taking the three meds that Prevpac is composed of, vs taking Prevpac.

Actually, it’s even sillier. Prevpac is a “kit” of the three meds - they’re not even rolled together into one capsule or pill. According to Drug Digest: “The Prevpac® ‘kit’ contains Trimox® (amoxicillin capsules), Biaxin® (clarithromycin tablets), and Prevacid® (lansoprazole capsules) packaged together. Generic Prevpac® therapy kits are not available.”

I don’t think pharmacists have the leeway to dispense the three meds as generics instead of the kit, so you’ll need to go back to your doctor and insist on prescriptions for the three meds indvidually.

6

[QUOTE=Joey P]
Are the dosages of each drug the same as what you can buy them in indivudally?

The doctor could just be dumb. My doctor told me to take Benadryl for a rash I had and was absolutly convinced that I’m better off taking Benadrly then Nytol (I was taking it becuase it was cheaper then Benadryl). Even after I explained to him that they are the same drug and the same dosage he still insisted on Benadryl. :rolleyes:
[/QUOTE]

I don’t know about those two specifically, nor the ones in the OP, but SOME brands of SOME medications do work differently, even if they have the same amount of the same active ingredients on their label. Most often, this is because one may use a different binding or filling agent, which breaks apart at a different part of the digestive cycle, causing different absorption. It’s also possible that some lines might have different levels of heat and/or light exposure, which can affect the breakdown of some chemicals compounds.

As for the specific drugs named, let’s hope a pharmacist wanders in…

But yeah, it sounds like maybe your doctor has stock in the company, or is itching for a complimentary cruise or somethin’.

7

Possibly the marketing folks from whatever company makes the Prevpac have gotten to her.

My doc has tried to get me to use an inhaler that combines a steroid and longer-acting bronchodilator, on a number of occasions. I’ve refused partly over concerns on the safety of one of the components, but primarily because with combo medications you can’t titrate one of the ingredients (up or down) when appropriate. My mother ran into this when she was given a combination inhaler and told to use it far too many times a day for one of the ingredients (memory is foggy on which combo this was) because she needed the higher dosage of the other :mad:.

The only reason to insist on a combination med (IMO) is if there’s a compliance concern. A valid benefit, however, would be if your insurance is structured with a max copay. If I have a scrip that costs 150 dollars, the most I’ll pay is, say, 20 dollars. If that scrip is a combo of 2 meds, I might have a copay of 20/apiece for the same medication - so the combo med is more cost-effective.

8

:smack: :smack: :smack: I forgot to mention. Call your doc (or whomever answers) tell them how expensive it is and ask for samples. They’ll probably have some on hand. At least that will help a little. My doctor wrote me a script for Nasonex in January, when I found out how expensive it was ($100/bottle) I asked for some samples. They must have put it in my file, becuase I’ve been on it for almost a year now and I haven’t paid for a single bottle, he just hands me 6 sample bottles everytime I see him.
BTW same deal goes for most meds the doc prescibes. As my MIL, the nurse, says…ALWAYS ask for samples.

9

[QUOTE=WhyNot]
I don’t know about those two specifically, nor the ones in the OP, but SOME brands of SOME medications do work differently, even if they have the same amount of the same active ingredients on their label. Most often, this is because one may use a different binding or filling agent, which breaks apart at a different part of the digestive cycle, causing different absorption. It’s also possible that some lines might have different levels of heat and/or light exposure, which can affect the breakdown of some chemicals compounds.

[/QUOTE]

Isn’t the concept of bioequivalence that the generic is certified bioequivalent only if it works exactly the same? I know that in our pharmacy there are a couple of drugs that say in big letters that they’re not.

Also, the thrilling conclusion to the story! After I stopped by the office, was assured that I was OK because I Have Insurance ™, and generic Biaxin isn’t on W-M’s 4 dollar list, called Wal-Mart back, asked about generics, called the doctor (she’s actually only an APN, but doctor is easier to recognize, and it’s all my school has) again, was told that she was busy with a patient, and would call me back. I leave a request that she just call the damn generics in again. Three hours later, after I’ve taken another two finals, I call back, she’s still busy, but will call me. She actually does a couple of minutes later. We talk, she still doesn’t want to do it because I got my Nexium filled recently, and the Insurance won’t cover a separate 14-day course of Prevacid (well, why did they cover the Prevpac, asshat?), and I mention that most of the things I’ve read about use Nexium or Prilosec ANYWAY for H. pylori infections, and she finally caves and calls them in. Final cost <8 dollars. Bitch.

10

[QUOTE=Joey P]
Are the dosages of each drug the same as what you can buy them in indivudally?

The doctor could just be dumb. My doctor told me to take Benadryl for a rash I had and was absolutly convinced that I’m better off taking Benadrly then Nytol (I was taking it becuase it was cheaper then Benadryl). Even after I explained to him that they are the same drug and the same dosage he still insisted on Benadryl. :rolleyes:
[/QUOTE]

Sorry, can’t follow what you are saying. If you wanted to take Benadryl, and it was prescribed, what is the issue?

11

[QUOTE=gotpasswords]
I don’t think pharmacists have the leeway to dispense the three meds as generics instead of the kit, so you’ll need to go back to your doctor and insist on prescriptions for the three meds indvidually.
[/QUOTE]

Actually, the doctor is able to indicate “may substitute with generic” or “may not substitute” on the prescription form. The former allows the pharmacist to fill the script with a generic equivalent at his/her discretion (which may or may not include cost to the patient or convenience as a factor) being that pharmacists have the training to make such judgment calls, and the latter says, no, you must fill this as written.

12

[QUOTE=Joey P]
The doctor could just be dumb. My doctor told me to take Benadryl for a rash I had and was absolutly convinced that I’m better off taking Benadrly then Nytol (I was taking it becuase it was cheaper then Benadryl). Even after I explained to him that they are the same drug and the same dosage he still insisted on Benadryl. :rolleyes:
[/QUOTE]

Did you try asking for “diphenhydramine”, which is the proper generic term for both of the name brands you refer to? I find that version to be cheapest of all.

13

[QUOTE=Cicero]
Sorry, can’t follow what you are saying. If you wanted to take Benadryl, and it was prescribed, what is the issue?
[/QUOTE]

The Benadryl package cost less money than the Nytol package for what appeared to be the exact same thing - a phenomena that occurs more often in medicine that most people realize.

14

[QUOTE=chaoticbear]
So I’ve been dealing with stomach crap for the last (almost) three months. I’ve been on various combinations of PPIs and acid reducers, all while my pharmacists told me it was an ulcer (two different doctors told me it was just reflux). So when my stomach started bleeding, the doctor sent me for an H. pylori test, and it came back positive. So she called in a Prevpac for me, which after insurance is $75. The three medicines separately, though, are going to be considerably less (the Biaxin and amoxicillin, especially). But she doesn’t want to give them to me separately? Is there any reason for this? She shouldn’t be worried about compliance, I’m a normal-memoried 21 year old!

My guess is that the drug reps have gotten to her, because she mentioned that “this combination is the most proven effective combination”. What gives?
[/QUOTE]

There is no therapeutic difference between generics and brand names, and no difference between taking the PrevPac and their generic equivalents prescribed individually.

15

[QUOTE=Chief Pedant]
There is no therapeutic difference between generics and brand names, and no difference between taking the PrevPac and their generic equivalents prescribed individually.
[/QUOTE]

Hooray! Now the only drawback to finally getting treated is that it’s added 7 pills to my daily regimen. I can hardly close my pill-minder now (most of it is vitamins though)

16

[QUOTE=Broomstick]
Actually, the doctor is able to indicate “may substitute with generic” or “may not substitute” on the prescription form. The former allows the pharmacist to fill the script with a generic equivalent at his/her discretion (which may or may not include cost to the patient or convenience as a factor) being that pharmacists have the training to make such judgment calls, and the latter says, no, you must fill this as written.
[/QUOTE]

Normally, that’s not a problem, but the prescription was for Prevpac, a collection of medications that has no generic equivalent, even though it is made of drugs that are available in generic. If the Rx fwas for Trimox, Biaxin, and Prevacid, then there would be no problem with the pharmacist offering up the generic equivalents of those drugs.

And yes, I’m unfortunately familiar with the term DAW (dispense as written) on prescriptions thanks to some really odd coverages by my insurance for thyroid replacements.

17

[QUOTE=WhyNot]
I don’t know about those two specifically, nor the ones in the OP, but SOME brands of SOME medications do work differently, even if they have the same amount of the same active ingredients on their label. Most often, this is because one may use a different binding or filling agent, which breaks apart at a different part of the digestive cycle, causing different absorption. It’s also possible that some lines might have different levels of heat and/or light exposure, which can affect the breakdown of some chemicals compounds.

[/QUOTE]

The only reason this ought to be true is if the different versions are targeted at different ailments (that is, their approved indications are different). For example, regular Tylenol vs Tylenol Arthritis; the later has been reformulated to release the dose more slowly, and so it will be less effective for a headache than the faster-acting version. You’ll see this a lot in OTC meds, since by the time a drug gets OTC approval, it is old enough to begin having generic competition.

Generally, though, for prescription drugs, the approved generic equivalent of a drug must be equivalent in pretty much every way except colour, markings and shape. Celexa, and drugs marketed as citalopram, must show equivalent efficacy results in clinical trials, they must have the same dosages, to within 2% (of the label claim, not of each other), they must display similar impurity profiles, similar dissolution rates… basically they must be identical in any way that may affect the use of the drug for whatever it is indicated for. If a doctor allows a generic substitution, the pharmacist will give the generic that has been identified as being equal, not some other medicine that happens to have the same ingredients. I believe Effexor and Effexor XR both come in similar dosages, but one (or it’s generic) is not a substitution for the other.

Generic diphenhydramine comes in different forms; pills, capsules, syrups, suppositories (yes, suppositories)… one may be a better choice than another for the particular symptoms that are being targeted, or for general allergy relief, they might all be equally effective.