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My psych nurse tells me that she sees the biggest difference between brand and generic medication performance with Wellbutrin, Adderall, and Lamictal. My insurance approved her DAW – dispense as written, i.e., brand name only – for Adderall XR, which I filled for the first time last week. 15 minutes after taking the first pill, when the gelcap dissolved and the drug hit my bloodstream, it felt like everything had changed.

I Can See Clearly Now

A week later, I can still hardly believe the difference. It’s not just that my symptoms are better controlled, but it’s also the extended release. It’s a true extended release, just like with brand Wellbutrin XL, and 40mg of amphetamines (two 20mg doses about 5 hours apart) doesn’t wear off in under 8 hours anymore. It lasts until I go to bed!

For me, this is practically inconceivable and nothing short of miraculous. I’m half terrified that it’s a placebo effect and my brain will stop working again next week, but it isn’t the first time that switching to brand drugs made this degree of difference. I might be able to reduce dosage because the brand name drug is that much more effective.

I’m telling you, friends, it’s like a brain transplant. Everything is better. Maybe that’s just coincidence with respect to mood, but reducing ADD symptoms also reduces anxiety and depression, because when I am better able to filter out stimuli, I’m less stressed on a systemic level. When I’m less stressed, I’m less anxious and less depressed. I even sleep better when I’m on stimulants, because my brain can actually shut off more readily when I go to bed.

The Same, But Different

The two brand drugs I’m taking are technically the same drugs I took for a dozen years as generics before things got truly out of control, but the difference in how well I can function while taking them is night and day. I can hardly believe I’ve been cheated out of this much quality of life by cheap-ass insurers, but I’m glad I now know the difference.

Why have I been denied the drugs that would have allowed me to function? Insurance doesn’t permit even trying the brand medication if a generic is available. Why? Cost and the myth of generic equivalency. Quoting from my initial denial letter for Wellbutrin XL:

according to your benefit, when a brand name drug has an FDA approved generic equivalent available, you must have failure or severe intolerance to a trial of at least 4 weeks of the generic and a completed MedWatch form must be submitted to the FDA documenting such failure or intolerance.

In addition, for Wellbutrin XL, I had to have tried the generic and at least two other drugs approved to treat depression, all for at least 4 weeks each. Never mind that all other drugs approved to treat depression very predictably make me extremely ill in under two weeks and always will, thanks to genetics.

How much money are we talking about, anyway?

My drugs are far from the most expensive brand meds out there – I can’t believe how much Abilify costs – but they don’t come cheap, even though they’re among America’s Favorite Meds. Prescription pricing is unregulated in many states, which is why large chain stores can offer certain common generic drugs for free or extremely cheap. Retail price versus negotiated price – insurers broker deals with pharmacies for prices – also makes a difference to perceived costs. My calculations use the prices my insurer negotiates with Rite Aid for the specific generics.

Given the combination of my location, insurer, and pharmacy, the generic extended release dextroamphetamine-amphetamine salts costs $253.15 for 60 x 20mg caps, which is a lot for a generic. It’s also sort of understandable because the active ingredients, amphetamines, are controlled and have actually been in shortage in recent history. Brand Adderall XR is $437.67, a difference of $184.52 per month, or $2,214.24 per year.

Generic Bupropion HCl XL costs $23.48 per month for 30 x 300mg tabs, but brand Wellbutrin XL costs $326.99, a difference of $303.51 per month from list price, or $3,637.12 per year. Notably, generic buproprion HCl XL has been shown to be non-equivalent to the brand, at least for one manufacturer’s 150mg tablet – which does not inspire confidence in any generic formulation of the drug.

Return on Investment

If I took generics, my drugs would cost $276.63 monthly, $3,319.56 annually. On the brand drugs, it costs $764.66 a month to keep me going, $9,175.92 annually. I may cost nearly three times as much to maintain on brand drugs, but my ability to function is also nearly tripled.

Restricting access to more effective meds based on cost is just plain foolish because spending the extra $5,900 each year actually saves a ballpark $32,000 of salary that is otherwise wasted. With the brand drugs, I can function adequately to work about 85% of the time, instead of about 30% of the time on generics. Anyone with half a brain can see that the return on investment is completely justified solely on an economic basis, before we even start discussing issues like “pain and suffering.”

So, naturally, I started wondering – what the hell can be making such a huge difference? It’s not the active ingredients because those are regulated, sort of. But my body is extremely sensitive and empirical evidence has clearly demonstrated that the arguments claiming the so-called sameness of brand and generic meds are bullshit.

I decided a little investigate journalism was in order and did some research. The results of my foray into the inactive ingredients in Adderall XR and Wellbutrin XL were eye-opening. I’ll be sharing my findings, analysis, and interpretation in Part Two later this week.

So, until I reveal my hand with the second part of this post, I’m curious to hear from you: have you ever had the experience of switching drug manufacturers, or switching from generic to brand medication, that yielded a night-and-day difference?

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