All clinicians should prescribe generic medications whenever possible to improve adherence to therapy and clinical outcomes as well as to lower healthcare spending, the American College of Physicians recommended in a “best practices” guideline. Simply prescribing generic drugs over their brand-name counterparts could translate to hefty financial savings for both patients and insurers. Indeed, although generics account for 90% of all prescriptions, brand-name drugs account for an estimated 79% of all drug spending. More affordable drugs can lead to better therapy adherence, which can result in better outcomes. In the spirit of better medication adherence, better outcomes, and cost-savings, here are seven commonly prescribed brand-name drugs that have recently gone or will soon go generic. Lyrica (pregabalin) In July 2019, the FDA greenlighted generic pregabalin for the following indications: neuropathic pain related to diabetic peripheral neuropathy, post-herpetic neuralgia, fibromyalgia, neuropathic pain secondary to spinal cord injury, and partial onset seizures. “[The] approval of the first generics for pregabalin, a widely-used medication, is another example of the FDA’s longstanding commitment to advance patient access to lower cost, high-quality generic medicines. The FDA requires that generic drugs meet rigorous scientific and quality standards. Efficiently bringing safe and effective generics to market so patients have more options to treat their conditions is a top priority for the FDA,” said Janet Woodcock, MD, director of the FDA’s Center for Drug Evaluation and Research (CDER). Pregabalin and gabapentin (Neurontin) are antiepileptics with similar structures resembling gamma-aminobutyric acid (GABA). However, neither drug acts like GABA. Generic pregabalin costs about $67 for thirty 150-mg capsules—about 70% less than branded Lyrica. Of note, generic gabapentin is still cheaper than generic pregabalin. Cialis (tadalafil) Phosphodiesterase type 5 (PDE5) inhibitors like tadalafil and sildenafil (Viagra) have given men a new lease on sex. The big difference between these two is the duration of effect, with sildenafil lasting up to 4 hours and tadalafil lasting up to 36 hours. In September 2017, generic tadalafil hit the shelves. For one-time use, 10-mg tadalafil is indicated. If used daily to help overcome erectile dysfunction, the starting dose is 2.5 mg. The price of a 30-day generic supply of 2.5 mg tablets is about $12—a 96% reduction of the average retail price of $314. When men take tadalafil, they have certain expectations. It’s fair to say that going blind is not one of them. One medical emergency to watch out for is sudden loss of vision in one or both eyes, which could be due to non-arteritic anterior ischemic optic neuropathy (NAION). Interestingly, those with a previous diagnosis of NAION can still take tadalafil, but only when the benefits (erection) outweigh the risks (blindness). Furthermore, patients with a “crowded” optic disc could be at increased NAION risk. Januvia (sitagliptin) In a perfect world, diabetes medications would be freely available to those who need them. As it is, the price of non-insulin diabetes medications like Januvia has increased by double the rate of overall drug prices. Notably, between 2014 and 2019, the cost of non-insulin diabetes drugs went up 76%. Metformin is a cheap generic available on low-cost formularies at pharmacy chains across the country. But up to 20% of those who take metformin experience gastrointestinal distress, and 5% end up quitting the drug. For these people, alternative options are very expensive. In 2022, generic sitagliptin, a well-tolerated and low-risk alternative to metformin, may come to market. Currently, the drug costs about $500 for a 30-day supply of 100-mg tablets. Along with diet and exercise, sitagliptin is used as monotherapy or combination therapy in type 2 diabetes. When combined with metformin, sitagliptin can decrease hemoglobin A1c levels by 0.65% to 1.1%. Amitiza (lubiprostone) Lubiprostone is a prostaglandin E1 derivative used to treat idiopathic chronic constipation caused by opioids, as well as constipation-predominant irritable bowel syndrome. It is a bicyclic fatty acid that activates ClC-2 chloride channels in the gastrointestinal tract, which causes the secretion of a chloride-rich fluid that softens the stool, boosts gastrointestinal motility, and promotes bowel movements. Generic lubiprostone is anticipated to come to market in 2021. Currently, sixty 8-mcg capsules will set a patient back around $400. Zubsolv (buprenorphine/naloxone) Zubsolv is a schedule III drug that is used to treat opioid dependence. Because the opioid crisis touches on all fields of medicine, physicians should rejoice to know that this drug is going generic and thus becoming more affordable for patients who need it most. Zubslov is more bioavailable than Suboxone, another iteration of buprenorphine/naloxone. Currently, Zubsolv costs about $145 for a month’s supply. This drug was anticipated to go generic in late 2019, and will hopefully be made available soon. Chantix (varenicline) This drug blocks nicotine from activating α4β2 receptors, thus inducing the mesolimbic dopamine system. Experts hypothesize that by triggering the mesolimbic dopamine system, varenicline mimics the physiologic reinforcement and rewards experienced with smoking. “In clinical studies, people who took varenicline were more likely to have a heart attack, a stroke, or other serious problems with their heart or blood vessels than people who did not receive this medication,” the NIH warns. “However, people who smoke also have a higher risk of developing these problems. Talk to your doctor about the risks and benefits of taking varenicline, especially if you have or ever had heart or blood vessel disease.” Currently, Chantix costs a bit more than $400 for a month’s supply. Zipsor (diclofenac) Zipsor is an NSAID used to treat the pain, swelling, and stiffness of osteoarthritis and rheumatoid arthritis. Extended-release tablets and delayed-release tablets are used to treat ankylosing spondylitis. This drug is also used to treat severe menstrual periods. Of note, patients with a recent history of myocardial infarction shouldn’t take this drug. According to the NIH: “People who take nonsteroidal anti-inflammatory drugs (NSAIDs) (other than aspirin) such as diclofenac may have a higher risk of having a heart attack or a stroke than people who do not take these medications. These events may happen without warning and may cause death. This risk may be higher for people who take NSAIDs for a long time.” Zipsor is anticipated to go generic in 2022. Until then, it costs more than $800 for one hundred 25-mg capsules. Source
