Episode 13: Generic Drugs for Parkinson’s

Dan Keller (00:09)
Welcome to this episode of Substantial Matters: Life and Science of Parkinson’s. I’m your host, Dan Keller. At the Parkinson’s Foundation, we want all people with Parkinson’s and their families to get the care and support they need. Better care starts with better research and leads to better lives. In this podcast series, we highlight the fruits of that research, the treatments and techniques that can help you live a better life now, as well as research that can bring a better tomorrow. Most of us opt for generic drugs whenever possible because of the cost savings. Even with insurance, co-pays can be significantly lower with a generic. However, when it comes to Parkinson’s medications, subtle differences can have a big impact for some people. Dr. Rajesh Pahwa, director of the Parkinson’s Foundation Center of Excellence at the University of Kansas Medical Center, talks about how generic drugs compare to branded products, from active ingredients to price. He also explains what to look out for when taking a generic drug, but first, to set the stage, he describes how an original brand name drug enters the market.

Dr. Rajesh Pahwa (01:27)
So a branded drug is a drug where a company either comes up with a new compound or drug or buys a new compound, and then they take it through clinical trials through the FDA to get approval. This may take 10 years or longer, and the company may spend hundreds of millions of dollars to get the product to the market. Because of the amount of money a company spends to get the drug, to develop it and bring it to the market, they are given exclusivity or patent life on these drugs, and depending upon how long it takes them to get it to the market, this patent life could be anywhere from 10 to 20 years. So once that patent expires, that’s when other companies can try to make similar drug, or actually the same drug, and that would be a generic drug from the branded product that’s made, because it’s not made by the original company under their brand, but it’s other companies making it, but it is still the same chemical.

Dan Keller (02:37)
So what is the advantage, if there is one, of using generic drugs?

Dr. Rajesh Pahwa (02:42)
When there is a branded drug, there’s only one company making the product. They, of course, price the product to how much money they have spent, what the market would bear, what the insurance company would pay. So there are a number of reasons how they price that drug. Once it goes generic, depending upon how much it costs to make the drug and how many companies are out there making the generic, they all start competing against one another, and that’s when the drug is cheaper, and that’s one of the biggest advantages of generic medications, that they are much cheaper than the branded drug.

Dan Keller (03:20)
So how similar or equivalent is the generic drug to the original branded drug?

Dr. Rajesh Pahwa (03:27)
The branded and the generic drugs are very similar. The FDA has very strict guidelines on how similar the drug can be, and they do give them a little bit of room, which is about 10% of what that drug is available in the body, and it has to pretty much be a similar drug with a similar amount of the drug that makes it into the body. So they cannot have a product where only, let’s say, 50% makes it into the body, or 150% makes it in the body. Ideally, you would like it to be 100%, and usually the branded drugs have a much tighter difference from one batch to the other. So they may have 2–3% difference, or maybe some may have 0% difference. But with the generic, there is a slightly more difference allowed by the FDA. So even though the chemical is the same chemical, the amount of drug that makes into the body may be slightly different.

Dan Keller (04:28)
So far, it sounds like they’re really almost exactly the same, plus or minus a little bit. But does using the generic translate into if it will work just as well in a person, and how well they’ll tolerate it?

Dr. Rajesh Pahwa (04:44)
So in Parkinson’s people, in majority of them, and by majority I mean close to 95% of them, they will not notice a difference going from a branded drug to a generic drug. Of course, there are some Parkinson’s patients who are very finely controlled, where they may be taking a quarter tablet at a time or, you know, half a tablet at a time, and for them, a 5%, a 10%, or a 20% difference could make it that their symptoms are not under control. Now this necessarily may not just be going from a brand to a generic product, it may be going from one company’s generic to another company’s generic, and they may also notice a difference at that time. But again, the important part is that close to 95% of the Parkinson’s people will not notice a difference. It’s a small group of patients who may notice that their symptom control may not be as good, or they may notice they’re having more side effects with the generic drug.

Dan Keller (05:48)
You bring up an interesting point, one generic of the original drug versus another generic. It seems sometimes pharmacies or pharmaceutical chains buy different generic drugs depending what they can get the best deal on, same compound, but made by different manufacturers. So how does someone say, well, I was very well controlled up till now, and something changed?

Dr. Rajesh Pahwa (06:13)
So again, you know, majority of the patients are not going to notice this difference. But again, the small percentage who may be sensitive and will notice a difference, they should always pay attention to what company’s generic they’re using. So the bottle will say that they are taking generic by X company. So if they get a new prescription filled and it has a different company’s name on it, and they feel they’re not doing as well, they could go back and ask the pharmacy if they could get them the generic made by the company that they were taking. At times, they may have to look for a different pharmacy who can provide the same generic, but that is one way to kind of try to get around switching from one company’s generic to another.

Dan Keller (07:00)
So far, it sounds like a generic would offer an advantage, mainly price, for most all of the patients. So how does a physician or a person with Parkinson’s decide that they’ll take a generic versus asking for the branded drug?

Dr. Rajesh Pahwa (07:17)
Majority of the people, we will start with the generic drug if a generic drug is available, mainly because of the costs involved, and even when the insurance company is paying, the co-pays are much lower with the generic drug. So if a patient goes from a branded product for which a generic was not available to a generic product, again, we would recommend taking the generic product first to find how they’re doing. Now, remember, the main difference between a branded and a generic may be the amount that’s in that tablet, so to speak. So if someone was taking carbidopa, levodopa 25/100 and they switch to a generic, that generic may be providing them with 108 milligrams of levodopa, or it may provide them with only 90 milligrams of the levodopa. So technically, if they took a little bit more, they will get enough to make the difference up. So even if someone feels that they’re not doing well on generic, taking a little extra levodopa should provide the same benefit, because they’re getting the same product, which would still be cheaper than going and buying the branded. However, some people are very sensitive. For them, even a little bit of change makes a big difference, and for them, their only option could be taking a branded drug.

Dan Keller (08:43)
Does this apply to most all of the drugs for Parkinson’s, or are there any which need to be so tightly controlled the amount you take that you would want the branded one all the time, i.e., that drug is made by the same manufacturer the same way, and you know it’s coming out of the same plant?

Dr. Rajesh Pahwa (09:03)
Usually, when we are looking at medications for Parkinson’s which have a long half-life or stay in the body for a longer period of time, and these would be medications where people are taking once a day, twice a day, three or even at times four times a day, they will not notice a difference going from branded to generic. However, if someone is taking a tablet, let’s say every hour, every two hours, even at times every three hours, then they may notice a slight difference going from branded to generic, because on one hand, their medication may only last for, let’s say, two hours, and they go to the generic, they’ll start noticing it’s only lasting for one and a half hours, and this commonly is levodopa or carbidopa levodopa, where they may be more sensitive than using medications like dopamine agonists or MAO-B inhibitors or COMT inhibitors, where you’re only taking it fewer times a day and changing to generic may not be as noticeable.

Dan Keller (10:02)
So what should a person with Parkinson’s ask or look for or do when they’re getting a prescription for a new kind of medication?

Dr. Rajesh Pahwa (10:11)
So every time a Parkinson’s patient fills a new prescription, they should make sure it looks the same as their previous medication bottle was. They should double check the bottle and see if the manufacturer is the same or different. After they start the new bottle, if they notice a difference in their control of symptoms, they need to discuss with their physician if maybe they need to change to the previous generic medications, or they need to adjust the dose of their medications if they are not doing as well after getting a refill.

Dan Keller (10:44)
Are there any policy or regulatory barriers now that keep people on branded drugs, which are more expensive, and if there are, are there any policy changes you would recommend?

Dr. Rajesh Pahwa (10:57)
So at the present time, the policy is more towards using generic drugs rather than branded drugs. Just because a drug is generic does not necessarily mean that an insurance company will cover that drug, because there may be multiple different forms of generic. For example, quick release versus a long acting drug, and a company may cover a quick release but may not cover a long acting of the same compound. So basically, every company, every insurance company prefers giving a generic product over a branded product, and if they do cover the branded product, there’s a much higher co-pay and much higher cost for the drug, and that’s why they usually avoid paying for a branded drug if a generic drug is available.

Dan Keller (11:47)
Have we missed anything, or is there anything interesting or important to add on the topic?

Dr. Rajesh Pahwa (11:52)
I think the most important point patients should realize is that the control of their symptoms between generic and branded drug is very similar. Close to 95% of the patients will not notice a difference going from a branded drug to a generic drug. Generic drug not only saves the patient money, but also the insurance company and the health system in general. So unless some patients are very sensitive to a generic drug, they should first try to stay with the same company’s generic drug before they go back to a branded product.

Dan Keller (12:30)
Excellent practical advice. I think people can follow that pretty well. I appreciate it. Thanks for taking the time to speak with us.

Dan Keller (12:46)
If you have questions about medications for Parkinson’s, branded or generic, call our toll free helpline at 1-804-PD-INFO. You can also visit our Ask the Pharmacist forum at parkinson.org/forums, where a registered pharmacist will answer your questions. Finally, remember that your local pharmacist is also a great resource. If you have any questions about the topics discussed today, or if you want to leave feedback on this podcast or any other subject, you can do it at parkinson.org/feedback. We’ll respond to some questions in future episodes. This episode of Substantial Matters was made possible through the generous donations of 1000s of people affected by Parkinson’s and a grant from Mylan. At the Parkinson’s Foundation, our mission is to help every person diagnosed with Parkinson’s live the best possible life today. To that end, we’ll be bringing you a new episode in this podcast series twice a month. Our next few episodes will focus on research, what’s new in clinical trials and why it’s important for you to get involved. Till then, for more information and resources, visit parkinson.org or call our toll free helpline at 1-804-PD-INFO, that’s 1-800-473-4636. Thank you for listening.

Dr. Pahwa is the Laverne and Joyce Rider Professor of Neurology at the University of Kansas Medical Center. He is also Chief, Parkinson and Movement Disorder Division and Director of the Parkinson’s Foundation Center of Excellence at the University of Kansas Medical Center, Kansas City, Kansas.

Dr. Pahwa received his MBBS (MD) degree at Seth G.S. Medical College, University of Bombay, India. He completed an internship in medicine at Baylor College of Medicine followed by a residency in Neurology at Baylor College of Medicine, Houston, Texas. He then completed a fellowship in movement disorders at the University of Kansas Medical Center. Dr. Pahwa is a Diplomate of the American Board of Psychiatry and Neurology.

Dr. Pahwa's research interests are centered around the various aspects of Parkinson's disease and essential tremor. He is currently involved in studies related to medical and surgical therapies for both disorders. Dr. Pahwa has published more than 250 peer-reviewed articles, chapters, and abstracts in leading neurology and movement disorder journals. He has conducted more than 100 clinical trials related to Parkinson's disease and other movement disorders. He is the co-editor of "Handbook of Parkinson's Disease," 3rd and 4th editions; "Therapy of Parkinson's Disease," 3rd edition; and "Handbook of Essential Tremor and Other Tremor Disorders." He is co-author of the book "Parkinson's Disease: Questions and Answers," 4th edition.