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Pain Management Message Board

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Thought I would add a few nuggets to the never-ending questions about different generics (and throw a more questions into the mix as well). From my reading on this board and research, I understood Watson, Roxanne, & Activas/Amide to be "better than average" and Ethex and Malinkrodt to be "worse than average." I thought Endo might lie somewhere in the middle to low range for quality.

Only one of the pharmacies I contacted was willing to order specific generics. The pharmacist said she would check on the cost of different generics for MS Contin and Oxyodone Ir. Most pharmacists told me that they stocked Malinkrodt and wouldn't change their orders for a regular customer. In this case, the pharmacist offered to look into the cost of Activas/Amide, Roxanne, Watson, and Endo. I don't know if I missed any other generics considered to be better than average -- if so, I would appreciate it if you could fill in the gap (for generic oxycontin IR and MS Contin.)

The pharmacist did a little investigating. Watson was the most expensive and not w/i whatever formula the pharmacy uses to calculate their minimum profit for a medication. I believe I have heard the best about Watson - if, indeed their product is closer to brand than the others, I wouldn't be surprised by the significantly higher cost of the generic.

The pharmacist explained that they could order Activas and Roxanne for *low* dose oxycodone and MSContin, but could not order these generic brands for a *high dose* of MSContin. I probably found this last bit the most interesting. At a certain dose level, some generic brands apparently become too expensive for the pharmacy [bear in mind that this is not very scientific analysis- it's an N of 1 ;-), at least in terms of a pharmacy willing to consider ordering a specific brand for a customer - I assume the cost of a generic to different pharmacies is the same, or that the hierarchy of prices is the same [I'm sure they vary according to quantity and possibly region - there may be other variables as well - but, again, I assume that the most expensive is still the most expensive, and so on..].

Malinkrodt seems to be the norm in this area. Another pharmacy that had been ordering activas/Amide for oxycodone has now switched to Malinkrodt and won't order the Activas/Amide brand now since they still have Malinkrodt in stock [there was a recall of the Activas/Amide last month]. At any rate, thought that this was a another interesting piece of the generics puzzle. If Watson is so expensive, why do any pharmacies stock it at all? The pharmacist didn't give me any of their costs, but the Watson was clearly far more expensive than the other generics. It seemed very obvious that Malinkrodt was the big price winner but the cost differential for Roxanne and Activas/Amide wasn't too large for lower doses of medications.

I would think that the large chains [depending on their management] would be better situated to purchase more "expensive" generics since they can purchase in bulk [but that's just an assumption]. I got this impresion after talking with a small independent today that doesn't stock any meds. for chronic pain b/c there aren't enough customers. When he *was* stocking these meds, he said his upfront costs were too high, and that the CP patients who got pain meds from the pharmacy often [?!] changed their dose or medication, and he was stuck with a expensive medication he couldn't sell - it just sat on the shelves and he lost money. In this case, it may have been that demand was too low over the long run to make it work financially.

So, I do have a questions here - for MS Contin, is Endo [the only other possibility the pharmacy offered for high dose MSC], a better bet than Malinkrodt? If anyone has experience or knowledge about how these two compare for MS Contin, I would appreciate it.

Also, Ex, if you happen to jump in here - you have mentioned many times that your dr. said "not to even *call*" if you got Mylan fentanyl patches b/c there were so many problems. Did your doctor ever say what he/she thought the problems were? I've looked at a lot of the threads about the difference between patch brands and I haven't really gotten a clear sense of the specific problems with Mylan. If you could summarize what you know, I would be grateful.

I'm curious if anyone regularly gets Watson, what kind of pharmacy they use, and if they had to request it. The same goes for high dose [she didn't specify what constituted high dose - if this started at 60 or 100 mg] of MS Contin.

One more question while we're at it - Anthem still lists LA oxycodone as a generic. Can they claim that there is actually generic LA oxycodone still out there? I thought it was all gone at this point. It makes a difference for some policies since some policies require you to pay the difference in cost between the generic and brand if the generic is available.

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