Generics vs. Brand Name Medication for ADHD

Generics, on the whole, are a great thing for people who have ADHD because they are so much less expensive than brand name medication.    There is even one generic (guanfacine) that is $4 at Walmart, Target, and other major discount pharmacies.    With this type of savings, it is no wonder that insurance companies are quick to insist on a switch from brand to generic when a generic comes available.

However, the important question is, are generics therapeutically equivalent to brand name medications when it comes to treating ADHD?  The answer is, they may not be.  This is not because generics are inferior.  It is because they are different.  When a company applies to have its drug approved as a generic it has to submit studies showing that their generic drug contains the same amount of the same active ingredient, that it is given the same way, that the blood concentrations be similar at similar times after taking the drug, etc.  Some generics may even be made by the same company, and at the same factory that the brand name medicine is made.  However, generics are permitted to vary in inactive ingredients and the blood concentrations do not need to be completely exact.  The FDA recently issued new guidelines for manufacturers regarding bioequivalence in generic extended release methylphenidate (Concerta), so this is a field that is changing.

As you may have experienced, psychiatric symptoms can be very highly sensitive to things like timing and blood concentrations at particular times.  ADHD can also become worse if the inactive ingredients include substances such as gluten or dye.  For some people, switching from one formulation of a drug (brand) to another (generic) can make enough of a difference that it is noticeable.  It could be a good thing, or it could be a not so good thing.

So, what can you do when you are prescribed a generic?  Well, first of all, give it a shot, so long as it is free of components which exacerbate your symptoms.  Make sure you keep an eye out for major decreases in effectiveness.  If necessary, your doctor can write "brand medically necessary" on the prescription, and fill out papers with your insurance company to try to persuade them to cover it.

If you do go with a generic, ask the pharmacist what kind you take.   Methylphenidate, for example, is made by several different companies and switching among the different preparations could be confusing for you.  Keep an eye on your pills and if they look different from month to month, ask the pharmacist what's up with the change.  If you find you have difficulties with switching, your doctor can also write "(insert manufacturer name here) generic medically necessary".  Typically the doctor would not have to intervene with your insurance company.

Remember, a generic typically results in a cost savings for you and for your insurer.  It can be the same as your brand name medicine, but it may be slightly different, so you should treat it as a different medicine, but not necessarily inferior.


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