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New regulations for Generic Medicines


nomoss
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Yes, came as a bit of a shock the other day at the pharmacie when a 'new' person behind the counter (don't think she is a pharmacienne .. more of a 'préparatrice') said to me .. you can't have that anymore, you will have to have the generic copy. This of a combined beta-blocker/anti-hypertensive drug that I have been taking for 8 years .. and which took me 2-3 years to get used to.

Then she jabbed a finger at the small photocopy notice on the counter. I read the notice and said .. no, I can pay to have the original if I want.

To which she replied that I was in luck as the generic was 'en rupture de stock' .. so I had escaped this time, unscathed.

Looking up online it seems that the generic copies .. when available .. might be ok.

But if they are not then I can say to my MT that I tried them but that they didn't suit me.

Phew .. don't fancy facing the harridan and having to say that.

We'll see what happens next time.
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Wooly I am most sympathetic to the health services plight as to the cost of drugs and the proliferation in the number of available drugs today.

So, I will, next time, try said generic copy for my current prescription but, if they don't suit me then I will hotfoot it straight to my MT to protest and ask her to support my request for my original drug.

It was a tad daunting the other day as, here in laid-back Brittany, we haven't seen the like of this harridan for at least 10/12 years. I thought such people had all either retired or died out.

All is usually sweetness and peace here.

I have a feeling that she might not last long here if she continues in her current manner .. pharmacies depend on continuing loyal custom so if the customers bu**er off to another pharmacy then smthg would need to happen.
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I am surprised to hear that this is recent as it has been practised here for some while.
The Doctor must write non substituable » et la raison de sa décision de ne pas autoriser la substitution par le pharmacien.

While I am happy to accept generics if they work equally well, one thing that can make a difference is the carrier part of the medicine (the 'packaging' part that makes it into a tablet for example) 

The active molecule  may be the same but the substance that it is bound into may not and some people may react differently to that

" Generics may differ in some characteristics such as the manufacturing process, formulation, excipients, color, taste, and packaging."

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I had the same problem yesterday.  The ordonnance was specifically from oncologist and said 'non-substitutable'.     The pharmacist pointed a finger to the notice on the front and said he could only prescribe generic but I could pay if I wanted original.    I pointed out that she had written 'non-substituable' but I still had to pay if I wanted the original, which is what I did.

I was under the impression that if it said 'non-substituable' then it had to be what was prescribed and was reimbursed.

My OH has a RV in May so we will ask the oncologist about it.  We will try another pharmacy next time and see if it is the same.

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[quote user="Laurier"]
I had the same problem yesterday.  The ordonnance was specifically from oncologist and said 'non-substitutable'.     The pharmacist pointed a finger to the notice on the front and said he could only prescribe generic but I could pay if I wanted original.    I pointed out that she had written 'non-substituable' but I still had to pay if I wanted the original, which is what I did.

I was under the impression that if it said 'non-substituable' then it had to be what was prescribed and was reimbursed.

My OH has a RV in May so we will ask the oncologist about it.  We will try another pharmacy next time and see if it is the same.

[/quote]

I'm trying to be polite. Please read the information in the link I posted to begin this thread.

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It isn't enough to just write 'non-substituable'.
The Doctor must also justify this by indicating the reason from a list of three situations:

"la raison de sa décision de ne pas autoriser la substitution par le pharmacien.

Trois situations médicales peuvent justifier ce refus et autoriser le recours à la mention « non substituable » :

  • MTE :

    lorsque le patient est stabilisé avec un médicament (restriction à

    certains principes actifs comme par exemple les antiépileptiques ou les

    immunosuppresseurs) ;
  • EFG : chez l'enfant de moins de 6 ans, lorsqu'aucun médicament générique n'est adapté ;
  • CIF :

    si le patient présente une contre-indication formelle et démontrée à un

    excipient présent dans les médicaments génériques disponibles."
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Thanks for that, Norman. I didn't know that. We have no problems normally with generics.  However, the oncologist was adamant that my OH should have the prescribed medicine (4 years on it now) and she confirmed that it was more effective than the generic, so I will ask her about justifying it in future, in line with the new regs.

Thanks - appreciate the explanation.

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The way the 'harridan' explained to me was .. the new software explicitly forbids, ie will not allow the non-generic, to be put forward to be reimbursed unless the pharmacist can tick the relevant box (as detailed by Norman/nomoss above) and has seen the evidence as to why.

The only way round it is to pay for the non-generic medicine .. with no reimbursement from either the state or your mutuelle.

Cracking the whip indeed.
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[quote user="suein56"] ...............................

The only way round it is to pay for the non-generic medicine .. with no reimbursement from either the state or your mutuelle.

Cracking the whip indeed.[/quote]

From the link I originally posted:
  • Si un vous refusez le médicament générique sans présenter d'ordonnance comportant une mention « non substituable »

    ou si cette mention n'est pas conforme, le pharmacien délivrera le

    médicament princeps mais vous paierez la totalité, sans bénéfice du

    tiers-payant. Vous devrez alors envoyer la feuille de soins papier à

    votre caisse d'assurance maladie qui le remboursera sur une base

    limitée à celle du médicament générique le plus cher du groupe générique

    correspondant
    . Si le prix du médicament princeps délivré est supérieur

    au prix du médicament générique, vous supporterez un reste à charge

    correspondant au différentiel de prix.

Cette mesure ne s'applique pas aux médicaments sous tarif forfaitaire de responsabilité (TFR).

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Like Norman, I too am surprised that this is a recent règle.

My onco must have known about this as long ago as 2018.  I had to have some special mouthwash (needed mixing up at the pharmacie) and as well as the special ALD ordonnance, he wrote that there was nothing else that could be prescibed (forgotten the actual words).

He gave me a 6 weeks supply but it only took 2 weeks for it to work on me.  Just as well as the cost was over 100 euros a week.

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One problem in the past was that a significant number of doctors and patients refused point blank to use generics on the grounds that they were not as effective or caused other problems.

This should now have been dealt with.

I think that those not prescribing generics can now be ‘investigated’ and perhaps fined.
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[quote user="nomoss"]
[quote user="suein56"] ...............................

The only way round it is to pay for the non-generic medicine .. with no reimbursement from either the state or your mutuelle.

Cracking the whip indeed.[/quote]

From the link I originally posted:
  • Si un vous refusez le médicament générique sans présenter d'ordonnance comportant une mention « non substituable »

    ou si cette mention n'est pas conforme, le pharmacien délivrera le

    médicament princeps mais vous paierez la totalité, sans bénéfice du

    tiers-payant. Vous devrez alors envoyer la feuille de soins papier à

    votre caisse d'assurance maladie qui le remboursera sur une base

    limitée à celle du médicament générique le plus cher du groupe générique

    correspondant
    . Si le prix du médicament princeps délivré est supérieur

    au prix du médicament générique, vous supporterez un reste à charge

    correspondant au différentiel de prix.

Cette mesure ne s'applique pas aux médicaments sous tarif forfaitaire de responsabilité (TFR).

[/quote]

Well I am delighted to read that nomoss .. as the harridan only mentioned no reimbursement .. perhaps she added 'tiers payant', if so then I didn't catch it. On the piece of paper on the counter It certainly didn't have the bit about being able to reclaim a partial refund via sending in a feuille de soins.
So, you are right to insist that we all read the original script.
So, as i said previously, I will try the generic in 3 months time and, if it doesn't suit me, then I will appeal to  my MT .. but if that fails then I shall not be averse to paying extra for my present medication as the overall cost, with a partial reimbursement, will amount to approx 50€ a year.
Perhaps this has come about at this time for me as generics were not previously avaliable for my particular medication. As you can see it is not an expensive drug .. but the combo is unusual.

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You may have missed
"

While I am happy to accept generics if they work equally well, one thing that can make a difference is the carrier part of the medicine (the 'packaging' part that makes it into a tablet for example) 

The active molecule  may be the same but the substance that it is bound into may not and some people may react differently to that

" Generics may differ in some characteristics such as the manufacturing process, formulation, excipients, color, taste, and packaging."

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Norman wrote : You may have missed

"While I am happy to accept generics if they work equally well, one thing that can make a difference is the carrier part of the medicine (the 'packaging' part that makes it into a tablet for example)

The active molecule may be the same but the substance that it is bound into may not and some people may react differently to that.

" Generics may differ in some characteristics such as the manufacturing process, formulation, excipients, color, taste, and packaging."

No I didn't miss your post Norman .. which I was most grateful for.

It is the 'carrier' bit which worries me the most ..

Some carriers can cause digestion problems .. and as I already have some of those problems I am v cautious about the possibility of the generic being unhelpful.

But as my medication comes in a box with 3 months supply I have time to make further enquiries .. forewarned is forearmed as is said.
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I would hope by now that the generic were the same, 'molecules' is it? as the original for most things?

They started dishing out generics donkey's years ago and I remember well all the folk I knew who simply didn't trust them, which was nonsense to me.

However, I would understand that some specific strong drugs may have strings attached to their being copied, so there could be differences, but for bog standard things, well, keep 'em cheap, helps the health service.

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