Clarifying changes in general medicine: generic vs. brand-name drugs and cost differences

Prompted by recent news headlines and TV segments—and given that I've spent quite some time working in the pharmaceutical industry—I feel a profound need to explain something to people that should have been clarified long ago by our sole, mandatory health insurer, Medicare. So, here's the deal: as of September 1st, primary care physicians aren't just being encouraged; they are actually being instructed to prescribe the most cost-effective medications that share the same chemical composition. We're talking about drugs that possess the exact same active ingredient as well as the same excipients. Essentially, when a company first brings a drug to market—after pouring massive resources into years of research on rats and humans—they hold an exclusive monopoly to set the price. But once that patent expires, they have to face reality: other generic manufacturers step in, utilizing those initial research findings (which was the most expensive part of production) to drive the price down. On the Medicare formulary (those "free medications" for patients), we have but not for every single drug , both the original brands and the generics—which are copies that must be 99.9% identical to the original, from the active substance to the inactive ones. Sometimes the original brand is more expensive, but in most cases, the company that pioneered the drug lowers its price to match the generics. Furthermore, it can actually happen that the price of the original brand ends up being cheaper than the generic version .
Another thing: on the drug formulary, alongside the medication itself, you'll see the NAME OF THE MARKETING AUTHORIZATION HOLDER listed here in the US. This means a situation can arise where one manufacturer has their drug on the list, yet they've actually licensed the right to sell that exact same drug to a competitor.
To give you a concrete example, let’s look at atorvastatin, a drug used to lower cholesterol. There are 14 different versions of it on the Medicare list!! 😲 At least 8 of those are priced identically for the same package size. So, which one will a primary care doctor pick? Any of them—they all cost the same.
Now, for those who feel very strongly about using only the "original" brand: okay, if you want Valium, you wouldn't ask for Normabel. But neither of those is actually the original!! Both are diazepams, and only Valium is from Roche (and it hasn't even been on our market for about 30 years) 😁
Innovative "originator" companies, in their hunger to maintain market monopolies, often have their representatives convince people that their drugs are superior—that they have "higher quality" active or inactive ingredients compared to generic firms. That sounds great, except sometimes (and increasingly often) they end up selling the rights to their own drug to another firm. It's similar to what Pfizer did with Zithromax. Where is Zithromax being produced now (under Barun Filipović)? 😂
The crucial point for all of us to remember—and I am a patient myself—is that any medication that has passed the rigorous checks of the European Union agencies, the American Pharmacists Association, and the FDA, fully meets the properties of the very first original drug... even if that original isn't even manufactured anymore. When I had to buy a medication abroad because it wasn't available here, I didn't mind paying $67. Later, when that same drug hit our market (though not on the basic formulary), I was just happy I didn't have to drive to Canada to get it, and I only had to pay $50. Eventually, that same drug appeared on our standard formulary for $20, and I didn't have to pay out of pocket anymore. Thank God for that medicine!!
To make this clearer for anyone reading this: the announcement that primary care doctors must prescribe the cheapest options is likely a message to those of us in pharma not to go chasing the debts the government owes us. As for anyone exploiting a patient's lack of knowledge... well, may their conscience handle that. Just like everything else.....

P.S. Admins, please don't move this post unless you consider it pretentious or malicious.

Hello,

I took the liberty of tweaking the title; I hope you don't mind. 🙂

It would be helpful if you could edit your post to include some spacing between paragraphs. It would make your points—which are actually worth reading—much easier to digest.

So, does this mean Medicare is going to tell hospital specialists they have to write down the generic name, while leaving it up to the primary care doctor to decide which specific brand actually gets prescribed?

Otherwise, there’s just no point in specialists bothering with the brand names at all.

Right now, we’ve got a situation where specialists aren't even following the Medicare guidelines for prescribing therapy. It leaves the patient stuck in a loop—the doctor tells them they don't qualify for the recommended drug under Medicare coverage, so their only option is to pay full price out of pocket using a private prescription.
Take stuff like Plavix, Preductal, or Singulair, for example...

swiftbear86 said:So, does this mean Medicare is going to tell hospital specialists they have to write down the generic name, while leaving it up to the primary care doctor to decide which specific brand actually gets prescribed?

Otherwise, there’s just no point in specialists bothering with the brand names at all.

Right now, we’ve got a situation where specialists aren't even following the Medicare guidelines for prescribing therapy. It leaves the patient stuck in a loop—the doctor tells them they don't qualify for the recommended drug under Medicare coverage, so their only option is to pay full price out of pocket using a private prescription.
Take stuff like Plavix, Preductal, or Singulair, for example...

Why on earth shouldn't they be allowed to write the brand name??
Patients have every right to be pissed off because they were given medication based on professional guidelines, and they have a right to receive it at no cost.
As for why the American Medical Association is denying them—honestly, I should probably say it's none of my business, but lately, we’re constantly having to call out the AMA regarding medications. To make matters worse, they’ve become incredibly arrogant recently; for instance, they won't even listen if you tell them $167 you're spending a fortune on meds every month—they just don't give a damn about what happens down here.

vividsailor7 said:Why on earth shouldn't they be allowed to write the brand name??
Patients have every right to be pissed off because they were given medication based on professional guidelines, and they have a right to receive it at no cost.
As for why the American Medical Association is denying them—honestly, I should probably say it's none of my business, but lately, we’re constantly having to call out the AMA regarding medications. To make matters worse, they’ve become incredibly arrogant recently; for instance, they won't even listen if you tell them $167 you're spending a fortune on meds every month—they just don't give a damn about what happens down here.

We’re currently hitting the same topic across two different threads, so I’ll leave it to the moderator to decide which one stays active for the discussion.
I really don't get why there’s this constant friction between the AMA, the specialists, the patients, and the pharmacies.

My approach is always the same: I tell patients that the specialist prescribes the specific therapy they believe is best for the diagnosis. Then, the AMA has to figure out if they can authorize an Rx under Medicare or if they have to issue a private prescription, which means the patient pays full price out of pocket.

The tension would be a lot lower if specialists warned patients upfront. Sometimes people simply can't afford the medication, and when that happens, the entire treatment plan just goes down the drain.

swiftbear86 said:We’re currently hitting the same topic across two different threads, so I’ll leave it to the moderator to decide which one stays active for the discussion.
I really don't get why there’s this constant friction between the AMA, the specialists, the patients, and the pharmacies.

My approach is always the same: I tell patients that the specialist prescribes the specific therapy they believe is best for the diagnosis. Then, the AMA has to figure out if they can authorize an Rx under Medicare or if they have to issue a private prescription, which means the patient pays full price out of pocket.

The tension would be a lot lower if specialists warned patients upfront. Sometimes people simply can't afford the medication, and when that happens, the entire treatment plan just goes down the drain.

The whole "argument" boils down to one thing: the pharmacist refusing to fill the Rx. That's the bottom line.
As for the rest of this nonsense, it feels like nothing more than misleading the patient.
A specialist doesn't need to provide a warning label for every script; they prescribe the appropriate therapy, period. The pharmacist's job is to dispense it exactly as written.

swiftbear86 said:We’re currently hitting the same topic across two different threads, so I’ll leave it to the moderator to decide which one stays active for the discussion.
I really don't get why there’s this constant friction between the AMA, the specialists, the patients, and the pharmacies.

My approach is always the same: I tell patients that the specialist prescribes the specific therapy they believe is best for the diagnosis. Then, the AMA has to figure out if they can authorize an Rx under Medicare or if they have to issue a private prescription, which means the patient pays full price out of pocket.

The tension would be a lot lower if specialists warned patients upfront. Sometimes people simply can't afford the medication, and when that happens, the entire treatment plan just goes down the drain.

Well, I see what you mean ( : OKP : ), but I have no idea how to split or merge posts without making a total mess of things.

The topics are clearly linked.

I think it’s best to just leave it as is for now. We'll see how it plays out.

That said, I agree with your observation; actually, I wrote something very similar on another thread.

vividsailor7, I hear you, but I think you're missing the mark on one point. This isn't about the AMA being stubborn (though, granted, some of your examples involve both stubbornness and unprofessionalism, but that's beside the point)—it's about the fact that they'll be penalized if they don't follow orders.

Think about it this way: if you were supporting a family on your salary and someone threatened to cut your pay in half or fire you, would you still pick a fight you can't win, or would you just do what you're told?

Suppose Medicare decided that any specialist who doesn't prescribe medication strictly according to their specific guidelines would face a pay cut. How would you react then?

vividsailor7 said:The whole "argument" boils down to one thing: the pharmacist refusing to fill the Rx. That's the bottom line.
As for the rest of this nonsense, it feels like nothing more than misleading the patient.
A specialist doesn't need to provide a warning label for every script; they prescribe the appropriate therapy, period. The pharmacist's job is to dispense it exactly as written.

It isn't about misleading patients; it's about following the official lists and Medicare guidelines.

The real question is why specialists aren't taking these issues to the drug commission to influence Medicare, rather than letting the hospital get penalized by having their budget slashed just because they didn't follow Medicare's specific rules.

After all, there are doctors sitting on that commission.

http://www.medicare.gov/guidelines

Felix - that's an excellent point you made at the end.
Once Medicare starts holding specialists accountable, things will actually start to change.

In my view, a patient should receive the best possible treatment based on medical standards. Specialists in certain fields should sit down with the commission and work it out, because right now, it feels like it's just a group of doctors who aren't even sticking to professional medical standards!!

vividsailor7 said:Why on earth shouldn't they be allowed to write the brand name??
Patients have every right to be pissed off because they were given medication based on professional guidelines, and they have a right to receive it at no cost.
As for why the American Medical Association is denying them—honestly, I should probably say it's none of my business, but lately, we’re constantly having to call out the AMA regarding medications. To make matters worse, they’ve become incredibly arrogant recently; for instance, they won't even listen if you tell them $167 you're spending a fortune on meds every month—they just don't give a damn about what happens down here.

Medicare basically holds the keys to the vault.
With that kind of power, Medicare gets to decide what’s covered and what isn't.
The problem is that Medicare doesn't always play by the same rules as the actual medical professionals.

Just because something is "legal" doesn't mean it's actually fair.

I don't want to drag this debate out on that other thread since it's already blowing up here, so I'm moving the quote over.

vividsailor7 said:I don't have any interest in following some arbitrary set of rules, and frankly, I don't want to. The only guidelines I care about—the only ones that actually matter—are the official standards set by my profession. Period.
Period. Full stop.
I am being crystal clear when I tell my patients: you need to listen. Does someone actually have a right to demand prescription medication?
Look, if the insurance company denies the claim and blocks a patient from getting their medication again, I’m going to call them out directly. I'll make it crystal clear: I couldn't care less about Medicare's little guidelines or their threats of penalties. I don't care if they want to fine me. Period. I treat my patients based on the standards set by the American Medical Association, not some bureaucratic checklist. If I recommend a specific medication, then that is what gets prescribed. It’s that simple. You and Medicare are following the exact same playbook used all over the world, and because of that, a patient could literally die. It's reckless. I don't give a damn about Medicare's protocols; you are the ones denying the patient their medicine. Why even bother sending the claim in the first place if you're just going to block life-saving treatment?
And there they go again, blathering on about those guidelines like they actually know what they're talking about. They act so incredibly condescending, too—half the time they just slam the phone down in your face before you can even get a word in edgewise. Typical.
I only ever caved once, and that was only because she told me she couldn't care less if I decided to step up. $333 Monthly medication coverage for patients? Give me a break. They act like I’m living in some twisted Wonderland instead of reality. It's absolutely absurd.
I’ll tell them they should just go ahead and change their insurance provider or, better yet, file a lawsuit or report the whole thing!
Since we’re on the subject of cardiac medications, I have to bring up my own situation involving my father. It’s been a nightmare. He’s dealing with uncontrolled arterial hypertension and diabetes, plus he’s a post-MI patient with unstable VT and COPD. His current regimen includes Januvia, Clopidogrel, Preductal, Losartan, Foster, Sorits, Ramed, Nexium, and Nebilet. To make matters worse, the doctor actually refused to prescribe the first five of those! I had to step in and intervene myself just to get him what he needs. Honestly, it is an absolute disgrace.

And this isn't being "okay" toward your colleagues. 🤷 Sorry, but Medicare is king here. It's not like we have some other independent agency to turn to, so we're stuck with them, and apparently, you think you can just pick favorites. If they are the authority and they say a drug can't be covered without paying out of pocket, and you intentionally write prescriptions for drugs you know aren't on the basic free list—and then you go as far as telling patients to sue the medical board—then you're just being disrespectful to your peers. Honestly, it doesn't surprise me that they hang up on you or act rude.🤷

We all know how drugs get added to the Medicare list. You should all get together and pressure them to include what the experts actually recommend instead of screwing over the patients. As if being sick isn't enough, we don't need doctors fighting amongst themselves and pitting people against each other.

Look, Hrvoje, I get that you write what you think is best, but damn it, we don't live in a utopia. You can't just take the "not my problem" approach. How are you supposed to collaborate with other specialists when things get serious and require a team effort if you're busy bickering over fucking medications?😢

Nicholas Myers said:Hello,

I took the liberty of tweaking the title; I hope you don't mind. 🙂

It would be helpful if you could edit your post to include some spacing between paragraphs. It would make your points—which are actually worth reading—much easier to digest.

Thanks, Nicholas—the title is fine. I was writing in a rush and feeling pretty heated because I genuinely believe it’s wrong for the Secretary of Health to mislead patients with his statements. Look, if someone told me they were going to fill my high-end car with nothing but the cheapest possible oil, I’d be worried and angry—especially if I’m still paying full price for the service. It's perfectly reasonable to expect clarity. Someone outside the medical field shouldn't be expected to understand the nuances of medication any more than I understand engine oil specifications. That’s why I felt people needed a deeper explanation of how (and why) these things work. Of course, I'm not trying to take sides here—even though I actually work in the pharmaceutical industry—because at the end of the day, I'm just a patient using medication too.

Nicholas Myers said:Well, I see what you mean ( : OKP : ), but I have no idea how to split or merge posts without making a total mess of things.

The topics are clearly linked.

I think it’s best to just leave it as is for now. We'll see how it plays out.

That said, I agree with your observation; actually, I wrote something very similar on another thread.

vividsailor7, I hear you, but I think you're missing the mark on one point. This isn't about the AMA being stubborn (though, granted, some of your examples involve both stubbornness and unprofessionalism, but that's beside the point)—it's about the fact that they'll be penalized if they don't follow orders.

Think about it this way: if you were supporting a family on your salary and someone threatened to cut your pay in half or fire you, would you still pick a fight you can't win, or would you just do what you're told?

Suppose Medicare decided that any specialist who doesn't prescribe medication strictly according to their specific guidelines would face a pay cut. How would you react then?

I am sorry for starting a new thread, but I felt it was necessary to explain to patients that "cheaper" medications aren't necessarily lower in quality—and in many cases, the brand-name originals are actually among the top five most affordable options.
I also want to touch upon why—at least in my estimation—the Secretary made that statement. Prof. Ostojić is far too brilliant to make such a comment just to scare patients. However, we have to realize that Medicare—essentially, the government—owes a massive amount of money to the pharmaceutical industry (the pharmacies, the wholesalers, and the manufacturers). It is in Medicare's best interest for drug prices to drop as much as possible. Therefore, the statement that only the cheapest drugs will be listed is essentially a signal to Big Pharma to: 1. Lower their prices, and 2. Stop insisting on immediate debt repayment and instead agree to a partial settlement (not to mention the interest, which I won't even get into).😂

melloworca6 said:I don't want to drag this debate out on that other thread since it's already blowing up here, so I'm moving the quote over.

And this isn't being "okay" toward your colleagues. 🤷 Sorry, but Medicare is king here. It's not like we have some other independent agency to turn to, so we're stuck with them, and apparently, you think you can just pick favorites. If they are the authority and they say a drug can't be covered without paying out of pocket, and you intentionally write prescriptions for drugs you know aren't on the basic free list—and then you go as far as telling patients to sue the medical board—then you're just being disrespectful to your peers. Honestly, it doesn't surprise me that they hang up on you or act rude.🤷

We all know how drugs get added to the Medicare list. You should all get together and pressure them to include what the experts actually recommend instead of screwing over the patients. As if being sick isn't enough, we don't need doctors fighting amongst themselves and pitting people against each other.

Look, Hrvoje, I get that you write what you think is best, but damn it, we don't live in a utopia. You can't just take the "not my problem" approach. How are you supposed to collaborate with other specialists when things get serious and require a team effort if you're busy bickering over fucking medications?😢

This is absolutely true. A general practitioner shouldn't be prescribing something that goes against Medicare guidelines. A hospital specialist should be fully aware of those protocols; instead of passing the buck to a GP and saying, "Well, let them deal with the headache and explain it to the patient," they should be warning the patient that while they believe a specific therapy is better, it unfortunately isn't covered for free under current rules. If you truly believe the Medicare guidelines need to change to match modern treatment protocols, then send a formal petition to Medicare—or better yet, write to the medical boards and get a story out in the news.😁

Moving this quote over here too.

restlesspanther42 said:Please!

Regarding the drug formulary, there’s actually a specific set of regulations outlining how medications get added to the list. Everything has to be cleared by the Pharmacy and Therapeutics Committee

Professional medical associations or even the actual patent holders can submit proposals to change the guidelines, which they send directly to that aforementioned committee.

The guidelines determining how a medication is prescribed are strictly defined by a professional
association under the American Medical Association

Take Article 22, for example.

restlesspanther42 said:If anyone actually cares, this explains what the new guidelines mean and how you're supposed to handle them.

@vividsailor7
Sure, you can tell a patient they have a right to a specific drug, but you're required to include a clause on every single one of your findings stating that Medicare has the authority to issue a different drug of equal strength from the same class.

Here’s the directive as well.

Nicholas Myers said:Well, I see what you mean ( : OKP : ), but I have no idea how to split or merge posts without making a total mess of things.

The topics are clearly linked.

I think it’s best to just leave it as is for now. We'll see how it plays out.

That said, I agree with your observation; actually, I wrote something very similar on another thread.

vividsailor7, I hear you, but I think you're missing the mark on one point. This isn't about the AMA being stubborn (though, granted, some of your examples involve both stubbornness and unprofessionalism, but that's beside the point)—it's about the fact that they'll be penalized if they don't follow orders.

Think about it this way: if you were supporting a family on your salary and someone threatened to cut your pay in half or fire you, would you still pick a fight you can't win, or would you just do what you're told?

Suppose Medicare decided that any specialist who doesn't prescribe medication strictly according to their specific guidelines would face a pay cut. How would you react then?

Honestly, let them face the consequences. I couldn't care less.
And honestly, I see that termination notice as nothing more than a "eat or be eaten" ultimatum. If you aren't performing perfectly, they’ll come for you. It's pure predatory behavior. Trying to actually enforce any kind of disciplinary action through the SKZZ is basically impossible anyway—maybe you could get away with something minor at an OB, but trying that at a local Clinic or the Mayo Clinic? Forget about it. They wouldn't stand a chance.
And some run-of-the-mill dentist over there is going to end up handling colonoscopies, EGDs, EUS, treating GI bleeds, and all that? Unbelievable. I mean, seriously? The waiting list for a basic colonoscopy in my area is already stretching into its second year! It’s absolutely ridiculous.
And don't even get me started on interventional cardiology—we haven't even touched on TEE, TTE, coronary angiograms, and all that other heavy-duty stuff yet.
Regarding that last point—I already told you guys about my colleague, the diabetologist over at Holy Spirit. She reported the Januvia and Inegy prescriptions to Medicare, and the Institute confirmed she did everything by the book. Of course, the LOM went absolutely ballistic about it. Typical.

velvetmoose9 said:Medicare basically holds the keys to the vault.
With that kind of power, Medicare gets to decide what’s covered and what isn't.
The problem is that Medicare doesn't always play by the same rules as the actual medical professionals.

Just because something is "legal" doesn't mean it's actually fair.

Well put.
Look, I couldn't care less about Medicare and their endless, suffocating guidelines. Honestly, who actually gives a damn?

Morgan Morgan5 said:This is absolutely true. A general practitioner shouldn't be prescribing something that goes against Medicare guidelines. A hospital specialist should be fully aware of those protocols; instead of passing the buck to a GP and saying, "Well, let them deal with the headache and explain it to the patient," they should be warning the patient that while they believe a specific therapy is better, it unfortunately isn't covered for free under current rules. If you truly believe the Medicare guidelines need to change to match modern treatment protocols, then send a formal petition to Medicare—or better yet, write to the medical boards and get a story out in the news.😁

Not one single bit of that should be handled by some hospital specialist or the SKZZ.

swiftbear86 said:It isn't about misleading patients; it's about following the official lists and Medicare guidelines.

The real question is why specialists aren't taking these issues to the drug commission to influence Medicare, rather than letting the hospital get penalized by having their budget slashed just because they didn't follow Medicare's specific rules.

After all, there are doctors sitting on that commission.

http://www.medicare.gov/guidelines

Felix - that's an excellent point you made at the end.
Once Medicare starts holding specialists accountable, things will actually start to change.

In my view, a patient should receive the best possible treatment based on medical standards. Specialists in certain fields should sit down with the commission and work it out, because right now, it feels like it's just a group of doctors who aren't even sticking to professional medical standards!!

Look, I couldn't care less about Medicare's guidelines. Honestly, their rules don't affect my life one bit, and frankly, I have zero interest in whatever kind of relationship they have with the American Medical Association. It’s all noise to me.
As for actually punishing these specialists? Honestly, it’s just not going to happen. You might be able to squeeze some accountability out of the smaller local clinics, sure, but trying to go after someone at a major institution like the Mayo Clinic? Forget about it. There isn't a damn chance.
On top of that, they’ve had that option to enter the LOM code since around November of last year, and as we can clearly see, absolutely nothing has changed. Not a single thing. That dentist is just all bark and no bite—nothing but empty threats.
And if—by some miracle, which I find absolutely impossible—they actually go through with it, I’ll be more than happy to send every single patient scheduled for a colonoscopy or an EGD straight to Medicare, just like they do with that insignificant dentist.

melloworca6 said:I don't want to drag this debate out on that other thread since it's already blowing up here, so I'm moving the quote over.

And this isn't being "okay" toward your colleagues. 🤷 Sorry, but Medicare is king here. It's not like we have some other independent agency to turn to, so we're stuck with them, and apparently, you think you can just pick favorites. If they are the authority and they say a drug can't be covered without paying out of pocket, and you intentionally write prescriptions for drugs you know aren't on the basic free list—and then you go as far as telling patients to sue the medical board—then you're just being disrespectful to your peers. Honestly, it doesn't surprise me that they hang up on you or act rude.🤷

We all know how drugs get added to the Medicare list. You should all get together and pressure them to include what the experts actually recommend instead of screwing over the patients. As if being sick isn't enough, we don't need doctors fighting amongst themselves and pitting people against each other.

Look, Hrvoje, I get that you write what you think is best, but damn it, we don't live in a utopia. You can't just take the "not my problem" approach. How are you supposed to collaborate with other specialists when things get serious and require a team effort if you're busy bickering over fucking medications?😢

It’s not that I’m being unreasonable—it is actually exactly the opposite. They are the ones being completely reckless and irresponsible because they refuse to dispense the medication.
I honestly don't get it—how on earth can a doctor just accidentally prescribe a medication? Seriously, how does that even happen?
My own family can't even get online anymore—they've basically degraded themselves to the level of an SKZZ clerk.
I’m going to say this one more time: Medicare and its endless, bureaucratic rules have absolutely nothing to do with me!
When it comes to how everyone is working together on this, first off, the SKZZ is completely unified. As for the meds and those internal prescriptions? Honestly, only a few smaller hospitals are even handing those out—I’m not even sure if anyone in a major city like New York does that anymore.
To answer your original question: honestly, when I deal with most doctors, clinics, or medical institutes, I rarely run into any issues at all. It’s just a matter of finding the right people.

restlesspanther42 said:Moving this quote over here too.

I've had enough.
The whole damn Mayo Clinic is talking about my post, and now it’s been tossed straight into the trash.

vividsailor7, take a deep breath and actually try reading what people are saying to you for once.

First off, you’re talking trash about your own colleagues. 👎 Second, you’re asking the AMA to turn against their own superiors. Look, Medicare is the one calling the shots for them, so they have to follow those guidelines. Since you’re so hell-bent on having them defy their bosses, tell me—are you going to go against your department head? Or the hospital director? See, going against a director or a boss is hard enough, but trying to fight the entire Institute? That’s just suicide.

I know plenty of cases where specialists acted like cowards and refused to push back against their bosses, even when they disagreed and we were dealing with serious illnesses. I won’t get into specifics because I’m not exposing people close to me online, and since it’s specific, anyone would know who I’m talking about, but there it is. A few of them didn't agree with the boss's decision, so they’d pull a patient aside and informally mention they didn't agree, but at the end of the day, the boss made the call and they had to roll with it. Then these same people come crawling in here, acting like primary care doctors aren't fighting windmills, as if they aren't up against an entire government agency and the whole system. 🤣 Give me a break.

Honestly, they aren't just paper-pushers, no matter how much they get belittled. They have to manage the Institute on one side, furious patients on the other, and doctors who do whatever they want and couldn't care less about anything else. It isn't easy.

vividsailor7 said:Look, I couldn't care less about Medicare's guidelines. Honestly, their rules don't affect my life one bit, and frankly, I have zero interest in whatever kind of relationship they have with the American Medical Association. It’s all noise to me.
As for actually punishing these specialists? Honestly, it’s just not going to happen. You might be able to squeeze some accountability out of the smaller local clinics, sure, but trying to go after someone at a major institution like the Mayo Clinic? Forget about it. There isn't a damn chance.
On top of that, they’ve had that option to enter the LOM code since around November of last year, and as we can clearly see, absolutely nothing has changed. Not a single thing. That dentist is just all bark and no bite—nothing but empty threats.
And if—by some miracle, which I find absolutely impossible—they actually go through with it, I’ll be more than happy to send every single patient scheduled for a colonoscopy or an EGD straight to Medicare, just like they do with that insignificant dentist.

It’s not that I’m being unreasonable—it is actually exactly the opposite. They are the ones being completely reckless and irresponsible because they refuse to dispense the medication.
I honestly don't get it—how on earth can a doctor just accidentally prescribe a medication? Seriously, how does that even happen?
My own family can't even get online anymore—they've basically degraded themselves to the level of an SKZZ clerk.
I’m going to say this one more time: Medicare and its endless, bureaucratic rules have absolutely nothing to do with me!
When it comes to how everyone is working together on this, first off, the SKZZ is completely unified. As for the meds and those internal prescriptions? Honestly, only a few smaller hospitals are even handing those out—I’m not even sure if anyone in a major city like New York does that anymore.
To answer your original question: honestly, when I deal with most doctors, clinics, or medical institutes, I rarely run into any issues at all. It’s just a matter of finding the right people.

I've had enough.
The whole damn Mayo Clinic is talking about my post, and now it’s been tossed straight into the trash.

Sir,
I honestly don't understand why you feel the need to use such a tone. I will admit, I agree that "that dentist" is mostly just blowing smoke because he can't actually do anything to hospital specialists (other than, of course, the state adjusting your on-call pay slightly)—but this affects all of us working within the system in one way or another. If I—someone working in the pharmaceutical industry—am saying this to you, who is right there on the front lines, it isn't because I'm trying to play the hero. It's simply because I know how hard all of you work and how much of yourselves you pour into these patients. So, what does it cost you to meet them halfway when the system fails them?

It seems we aren't quite on the same page here.

vividsailor7 mentioned a situation where a primary care physician refused to prescribe a more expensive therapy to a patient who arrived with a specialist's recommendation, but if I understood correctly, that wasn't actually about generics. Back before the current reforms, Medicare eventually sided with the specialist.

I believe his concern lies in the possibility of such a scenario recurring. It isn't a matter of whether someone receives Bayer Aspirin or Pfizer (to use a loose analogy), but rather whether a patient can access an insulin analog if their endocrinologist determines it is necessary over standard insulin—or if a GP will deny the prescription simply because they deem the switch unnecessary.

I won't get bogged into the technical nuances between analogs and non-analogs, but the crux of the matter is that analogs lack generics and cost twice as much, even though they are all included on the essential drug list.

copperlynx22 said:It seems we aren't quite on the same page here.

vividsailor7 mentioned a situation where a primary care physician refused to prescribe a more expensive therapy to a patient who arrived with a specialist's recommendation, but if I understood correctly, that wasn't actually about generics. Back before the current reforms, Medicare eventually sided with the specialist.

I believe his concern lies in the possibility of such a scenario recurring. It isn't a matter of whether someone receives Bayer Aspirin or Pfizer (to use a loose analogy), but rather whether a patient can access an insulin analog if their endocrinologist determines it is necessary over standard insulin—or if a GP will deny the prescription simply because they deem the switch unnecessary.

I won't get bogged into the technical nuances between analogs and non-analogs, but the crux of the matter is that analogs lack generics and cost twice as much, even though they are all included on the essential drug list.

In my view, any instance where a primary care doctor ignores a specialist's opinion is definitely not in the patient's best interest—and it certainly shouldn't be allowed. I just hope that primary care doctors will be smart enough to argue with Medicare rather than causing harm to the patient. At the end of the day, a hospital specialist has a documented medical history where they can write a prescription that might even deviate from Medicare guidelines, provided it’s backed by their expert opinion. In fact, they don't just have the option—they must . However, since this discussion was opened specifically because of the confusion surrounding "cheapest" medication options, I don't want to veer too far off track. An analog of a drug is not the same as the prescribed drug; it's essentially a different drug under a different manufacturer's approval. No matter how similar the effect might be, it is a different medication, and I truly hope primary care doctors won't swap out what a specialist has prescribed.