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Rekonn

Accutane vs Generic

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Little introduction first - I'm a 28 year old male that has been dealing with backne since I was 12. My face has had some acne, but not much more than is typical. My back on the other hand has always had a range of little whiteheads to large painful mounds that seem to come from pretty deep. Leaning back in a chair was often uncomfortable, and I've ruined plenty of white tshirts over the years.

I've just started my second month of taking Accutane. I was on 40mg in my first month, and I've just been bumped up to 60mg per day (20mg, 3 times a day). I got my prescription, and was charged $60 for the one months supply. Because I was curious, I asked what it would cost if I didn't have insurance. The pharmacist said a little over $600 for the generic, and the Accutane was.... $1260!

Is there a difference between generic and the original?

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Little introduction first - I'm a 28 year old male that has been dealing with backne since I was 12. My face has had some acne, but not much more than is typical. My back on the other hand has always had a range of little whiteheads to large painful mounds that seem to come from pretty deep. Leaning back in a chair was often uncomfortable, and I've ruined plenty of white tshirts over the years.

I've just started my second month of taking Accutane. I was on 40mg in my first month, and I've just been bumped up to 60mg per day (20mg, 3 times a day). I got my prescription, and was charged $60 for the one months supply. Because I was curious, I asked what it would cost if I didn't have insurance. The pharmacist said a little over $600 for the generic, and the Accutane was.... $1260!

Is there a difference between generic and the original?

not really, no. they have different "filler ingrediants" but the actual medicine is the same.

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I've just been bumped up to 60mg per day (20mg, 3 times a day).

I imagine that the $60 is because you had to pay (3) $20 co-pays? If so, ask your derm to prescribe it as (1) 20mg and (1) 40mg a day to save you $20.

Regarding generic versus brand name - they have the exact same amount of the exact same active ingredient, and are required (in the US) to demonstrate bioequivalence. The approved US generics have an absorption profile that's nearly identical to the brand name. The only reason to choose one approved brand over another is if you are sensitive to the binders and dyes in one particular brand, since that's the only thing that's unique.

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I've just been bumped up to 60mg per day (20mg, 3 times a day).

I imagine that the $60 is because you had to pay (3) $20 co-pays? If so, ask your derm to prescribe it as (1) 20mg and (1) 40mg a day to save you $20.

Regarding generic versus brand name - they have the exact same amount of the exact same active ingredient, and are required (in the US) to demonstrate bioequivalence. The approved US generics have an absorption profile that's nearly identical to the brand name. The only reason to choose one approved brand over another is if you are sensitive to the binders and dyes in one particular brand, since that's the only thing that's unique.

Can you help me out, i want to know why the CIPLA brand isn't approved in the U.S, would you happen to know?

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i read a study on the differences in accutane manufacturers, from what i remember shelf life was a big difference between them. in the generic the acitve ingredient declined quite a bit faster while the name brand had a longer shelf life.

La roche standards of production are better. But still the same stuff inside the pill.

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It's made in India, and they don't perform the inspections and such that the FDA requires. I wouldn't take that brand personally.

Actually, the thing about inspections isn't true. At least one of the FDA approved isotretinoin generics Sotret is made by Ranbaxy, which is an Indian company. In addition, Cipla, the manufacturer of Isotroin has several generics approved by the FDA.

I'm only mentioning this to say that Indian pharmaceutical companies have an excellent reputation world-wide and are generally felt to be as modern and as advanced as any in the world. They are fully capable of meeting FDA standards. This includes Cipla.

The Cipla brand of isotretinoin is indeed not approved by the FDA, but to assume that it is because of lower quality or poor manufacturing standards is not an assumption that I would make. It could indeed be that it is low quality. But I don't believe that is so. Much more likely is that the manufacturer either (1) is trying to get approval but has not completed the process or (2) is not seeking to enter the US market, probably because the cost/benefit of going through the approval process is not worth it.

On the other hand, your advice to not use a non-FDA approved generic is not bad at all. One should be very, very careful when doing so. But across the board dismissing of Indian pharmceuticals would be a mistake.

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You might be onto something though, because they have kept their prices very low by not introducing it to the American market.

I personally am taking the Cipla brand of accutane, and i live in the U.S, it's much cheaper, and i'm pretty sure it works.

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On the other hand, your advice to not use a non-FDA approved generic is not bad at all. One should be very, very careful when doing so. But across the board dismissing of Indian pharmceuticals would be a mistake.

I didn't intend for it to sound that way, shouldn't have even mentioned that it is made in India. All i know is that it has not gone through the FDA approval process and i read somewhere (sorry, i don't remember where) that it was because they did not want to comply with the inspection requirements.

i read a study on the differences in accutane manufacturers, from what i remember shelf life was a big difference between them. in the generic the acitve ingredient declined quite a bit faster while the name brand had a longer shelf life.

La roche standards of production are better. But still the same stuff inside the pill.

The generics which they quoted as having a poor shelf life were not the ones approved in the US. And the measurements of shelf life did not actually check to see if the effectiveness of the med had changed. If the color of the gel changes a little, but it still works, does that really matter? And how long does a package of isotretinoin typically stay on a shelf anyway? That study was interesting, but not particularly useful when making a decision. I have personally taken both the Roche brand name Accutane (back before the patent had expired) and an approved generic (Claravis) and they both worked fine. But the Claravis was about half the price.

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Good to know, thanks for the replies. Yes, I'm in the US, currently in Arizona. On the prescription, my dermatologist specified that it was not to be switched with generic, so I was curious. $600 a month difference between two identical products, and yet because of insurance, the consumer (me) has no incentive to switch. Interesting to see the reason for spiraling health care costs first hand.

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Good to know, thanks for the replies. Yes, I'm in the US, currently in Arizona. On the prescription, my dermatologist specified that it was not to be switched with generic, so I was curious. $600 a month difference between two identical products, and yet because of insurance, the consumer (me) has no incentive to switch. Interesting to see the reason for spiraling health care costs first hand.

The doctor doesn't bother prescribing an equally effictive and less costly medication just because the insuranc ewill cover it. This is all too common and totally unethical in my opinion.

And doctors wonder why insurance companies (and government payers) want more control over costs and want to require doctors and hospitals to do more documentation (paperwork) to justify care. Doctors bitch about this as if it's totally unnecessary and a bad influence on patient care. To me, anyone who pays any bill - whether it be you paying your plumber or an insurance company paying a doctor - has every right to questioning costs. Doctors, as a group, are used to being totally in charge and accountable only to themselves. They don't realize that the people paying the bills have the right to demand reasonable financial decisions.

As paitents we also need to hold their feet to the fire and demand to know why the expensive brand name is prescribed without the option of cheaper generic substitution.

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A month has passed by, and my dosage was again upped from 60mg to 80mg daily. I thought about advocating harder for the generic, but what was I going to say? I'd feel stupid going against someone with a medical degree and decades of experience after just reading a couple pages on the internet.

So, I went with the brand name again, and was really curious how much it would cost without insurance this time. Went to the same CVS, presented the pledge card, and 10 minutes later my prescription was ready. My copay was once again $60, but without insurance it would have cost...drumroll... $1090. What the?! Why is 80mg cheaper than 60? My prescription now is two 40mg pills vs three 20mg pills daily - the extra cost must come from the packaging, lol.

30days x 60mg = 1800mg = $1260 = $.70/mg

30days x 80mg = 2400mg = $1090 = $.454/mg

$.454 x 1800 = $817

$1260 - $817 = $443

If my arithmetic is right, that's $443 in extra packaging cost!

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Yup, I do have insurance. Every time I fill my prescription, all I pay is the $60 copay. I just like to ask the pharmacist what it would cost without insurance because I'm curious.

My first job out of college was at a small alternative treatment insurance fulfillment company. When chiropracters and massage therapists wanted to be paid by the patient's insurance company for services rendered, they would submit a claim to us. You need checks and balances because otherwise some patients would see their therapists forever. Insurance companies were obligated to pay for a patients medical condition that improved with treatment, but not to make them feel good indefinitely. I worked on coding the system that automatically approved most claims, rejected some, and set aside others in a gray area for actual doctors to review.

Knowing that insurance companies have systems in place to prevent paying when they don't have to, it just surprises me that drug companies can get away with charging $440 for what is at most $5 worth of packaging.

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