Stretching your medical scheme benefits

A recent study showed that most people – even doctors and pharmacists – view generic medicine as less effective than branded medication. But opting for generic medicine, is the most effective way to stretch your medical scheme benefits and to ensure that you limit co-payments that may be charged by your scheme, says Andy Gray, a senior lecturer in the Division of Pharmacology at the University of KwaZulu-Natal. We asked Andy to clear up some of the misconceptions about generic medicine.

What is generic medicine?

A generic is a follow-on product, a copy of a branded medicine that is designed to be as good and to achieve the same outcomes as branded medicine, but at a lower price.

Are generics just as good as original medicine?

Before any medicine is made available to patients, it has to be approved by the Medicines Control Council (MCC) of South Africa. The manufacturer of generic medicine has to prove it, certifying that it is as good as the branded version and can be used instead.

Are there any differences between original medicine and generics?

Yes, there are, but any differences between generic and branded medicine are minor, and may relate to the colour, shape, coating or perhaps taste of the medicine.

Generally, the inactive ingredients are also the same or very similar, in order to ensure that the medicine is as close to the branded version as possible. The active ingredient may be made in a different factory, but must be identical. Any differences that are detectable are not expected to have any clinical significance. Both the desired effects and side effects are expected to be the same.

Are generics available to treat all conditions?

No, they are not. When a new medicine is patented, only the patent holder may make that medicine for 20 years, unless a licence is issued for a copy to be made. For some conditions, only new, patent-protected medicine will be available.

Can I ask my doctor to prescribe a generic? 

Yes, that is your right. You can ask for a particular generic, or you can ask your doctor to prescribe medicine, using the international non-proprietary name. In all cases, unless the doctor has written ‘no substitution’ on the prescription, the pharmacist must offer a generic if one is available.

Can I ask my pharmacist for a generic drug if he/she doesn’t offer?

The law provides for the mandatory offer of generic substitution. However, if a pharmacist does not offer a generic, you are at liberty to ask whether one is available for the medicine that has been prescribed. Pharmacists are not required to have every generic medicine in stock, but should be able to order any generic that is marketed in the country. You also have the right to refuse any substitution, but that may result in additional costs.

Can I stretch my medical scheme benefits by opting for generic medication?

Using a generic, is a very important way to stretch your benefits and to ensure that you limit the copayments that may be charged by your medical scheme (in the case of managed care programmes). A pharmacist may not dispense a more expensive version than the one that was originally prescribed.

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