Saturday, August 15, 2009

The Issue of Generic Cellcept

Earlier this year, the generic version of Cellcept came into the market after Roche's patent on Cellcept expired in May of this year. This was and is still a much discussed topic. On the issue of kidney transplant medication or immunosuppressive medication as a whole, the issue of generics is a very touchy subject.

There are actually two main causes of this, on one side, is cost. Transplant medications are very expensive. Depending on what doses and which drugs you are on, costs may range from high to exorbitant. Not to mention that, more often than not, you have additional drugs and supplements aside from the anti-rejection pills.

At the other end, is drug efficacy. How well does the generic drug, in this case Cellcept, stack up against the branded one. Patients who have had their transplants have been on the Cellcept brand for a while and are now facing the choice between the cheaper generic and costlier but proven brand.

The sad fact of the matter is, as much talk as there is, transplant patients may not really have a choice. Most patients have their transplant medications covered by some sort of health insurance. In most cases, it has been the insurance agency that is prompting the move to generic. For those who pay out of their own pockets, depending on where you source your immunosuppressive drugs, the cost difference between Cellcept and its generic may vary from 10% to more than 50%.

Doctors, on the other hand, are more hesitant. Given the option, they prefer that patients take the branded product. As a whole, they seem to agree that the difference in efficacy matters. Some say there is a 10% variance, others say the effects may be +15% or -15% the effect of the branded product depending on the person taking it.

Another thing they seem to agree is that though they prefer that we use the brand name, and should you shift to generic, to make sure to inform them so that they may monitor your progress and the cellcept blood levels closely during the initial conversion period.

So what has happened since?

Some transplant patients have avoided the generic because their doctors and clinics forbid it. Their doctors have provided branded scripts that explicitly state “no substitutions”, “use branded name”, “no substitutes,” “original as written” and the like.

Others have opted to add to their co-pays or pay for the extra cost it takes to have the branded name.

One creative method I've heard from few was they were asked to switch to Myfortic because the insurance didn't want the branded Cellcept.

There are also quite a number of transplants who have moved and are now using the generic. Some clinics have given it the go signal for their patients.

Generally, the generic seems to be working okay. Some have said they have no problems with it, others say it is less troublesome for their stomachs. Then again, I've also heard a few problems like stomach issues and skin problems, proving once again that everyone reacts differently to medication.

Luckily, my being on Myfortic allowed me to sidestep this issue. But whichever way you look at it, this is a learning lesson for all of us. It has happened before, with cyclosporine (Gengraf) and now Cellcept, and it will happen again.

Soon, Prograf will have a generic then all our other drugs will go past their patent. At least next time, we'll be better prepared.

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