Medicines: how to save money and is it worth it

Medical products (drugs, medicines, vitamins, medicines) are mentioned for informational purposes only. We do not recommend using them without a doctor’s prescription. Recommended reading: “Why can’t you take medications without a doctor’s prescription?”. Over the past few years, drug prices have risen by 30-100%. There are also drugs, the cost of which has increased several times, so it is not surprising that ordinary consumers say that treatment is expensive. Let’s consider how true this statement is, because drugs with the same composition are produced under different names and, accordingly, cost differently.

In 2018, the State Duma of Russia passed a law obliging pharmacists to offer patients not only expensive medicines, but also cheaper analogues. The Ministry of Health of Ukraine allows doctors to write a prescription for an international non-proprietary name. In this way, users were able to independently choose the manufacturer and price category of medicines. Similarly, you can do the same with self-medication and buying over-the-counter drugs, choosing products in the medium and low price category. This will significantly save the family budget.

The most popular groups of drugs

When forming a home first aid kit, following the recommendations of a doctor or trying to get rid of symptoms, conditions or illnesses on your own, you should pay attention not only to expensive original drugs, but also to their cheaper counterparts. Let’s try to compare several popular groups of drugs.

Non-steroidal anti-inflammatory drugs with analgesic effect. A fairly popular remedy is diclofenac capsules, which are often taken by elderly people to relieve pain and inflammation in arthritis, sciatica, and bursitis. Comparing the original German drug Dicloberl Retard capsules 100 mg, 20 pieces per pack and any domestic analogue, it is easy to see: the price may differ by 5-10 times, but the effect is similar.

Antiseptic preparations for diseases of the throat. One of the most popular remedies is Strepsils, which is available in different flavors (orange, eucalyptus, honey-lemon, original, sugar-free). It is often recommended in pharmacies, because it contains a good antiseptic dichlorobenzyl alcohol. Finding cheaper analogues of the drug is easy. For example, Vokacept lozenges, the cost of which is half that.

Antifungals used for acute vaginal candidiasis in women. One capsule of French Diflucan will cost 10 times more than any drug based on fluconazole, which is the active ingredient.

Antidiarrheal drugs that reduce intestinal smooth muscle motility, which are quite popular. Often, the pharmacy recommends Imodium capsules, which can be replaced with domestic loperamide.

Is it always worth choosing cheap analogues

To answer this question, you must first understand what the price of the medicine depends on. The production technology affects the cost of each drug. Original products go a longer way: from the synthesis of a substance, through the study of its properties and clinical trials, to entering the market. This can take 12-15 years, and sometimes even 20. Analogues, which can be released only after the end of the original patent, “jump” several stages at once. One of them is clinical trials, therefore, accordingly, the cost is several times lower.

But the lack of clinical trials is far from the only reason why drug substitutions may not be feasible. An important point in the treatment of pharmacological drugs is their bioavailability, which determines what the therapeutic effect of the drug will be, how quickly it will come, and the severity of side effects. For example, the Institute of Pharmacology of the State Medical University in St. Petersburg, comparing the original azithromycin and its analogues, found that due to the slower absorption of cheap antibiotics, their bioavailability decreases ^[1]. Accordingly, the clinical efficacy is several times lower, and in fact such drugs are intended for the treatment of serious infections.

Another important point is the influence of auxiliary fillers. In any form of drugs, they are not chemically inert, and are often able to react with the active substance, thereby affecting the quality of the drug. ^[2], its pharmacokinetics and pharmacodynamics change:

• drug solubility;
• the release of the active substance and the time it takes to reach the maximum concentration;
• metabolism, excretion;
• effect on the body, especially in the presence of concomitant diseases.

Due to such interactions, the concentration of active substances may also differ. Chemical comparisons of original products and analogues revealed that this figure often reaches a difference of 7%. This means that the patient may not receive the dosage he needs.

And the last thing that is of particular importance for the possibility or impossibility of replacing drugs is equivalence. There are three characteristics of this indicator:

• therapeutic – most patients, in addition to the main diagnosis, suffer from other diseases, so drugs should act on organs and systems in absolutely identical ways;
• pharmaceutical – in this case, the medicinal product must have the same composition, form of release and contents of the components;
• clinical – tolerability of drugs must also correspond to the original.

Situations in which substitution is strictly prohibited

It is not recommended to change prescription drugs to the patient and the pharmacist without the consent of the doctor. However, often the same applies to over-the-counter drugs.

To date, medicine uses two replacement systems. The first, total, provides for the possibility of using analogs that are the same in bioavailability, equivalence, pharmacokinetics and pharmacodynamics. When writing a prescription for such funds, the doctor puts a special mark with permission. In this case, the pharmacist determines which drug is suitable for the patient.

The second, forbidding, does not make it possible to choose analogues instead of the prescribed remedy. The doctor should note this in the prescription. For example, it is strictly forbidden to change such pharmacological groups of drugs as β-blockers, Ca antagonists, antiepileptic drugs. And this is far from an exhaustive list.

Also, the replacement of drugs with analogues should not be made if:

• there are serious pathologies, especially the liver and kidneys, because the metabolism of different drugs is significantly different.
• the patient has a history of diabetes mellitus, since some manufacturers add taste correctors based on sucrose and glucose to their preparations to improve taste.
• drugs are intended for children and elderly patients ^[3].

How is it in other countries

In different parts of the world, the issue of savings due to the replacement of medicines with cheaper ones is treated differently. For example, in the USA and Canada, this is possible only if the doctor has not noted the prohibition of replacement. In the UK, this is completely ruled out. The pharmacist must release only the remedy indicated in the prescription.

Denmark is more loyal – to replace a doctor, it is enough to “give the go-ahead”, and the French Ministry of Health even encourages prescribing cheaper drugs ^[4]. This country even has a system of fines for prescribing expensive drugs.

If you are still going to choose cheaper analogues, you should definitely consider which group of drugs is prescribed by the doctor or which symptoms you need to get rid of. If the situation is serious, you should not replace the drugs yourself.

Savings must be reasonable!

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