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The Final Word On Brand-Name Vs. Generic

Something to consider next time you're buying over-the-counter drugs.

Jason Silverstein

Supported by Oscar

Sometimes a brand name signifies higher quality. As an example: "One might choose brand-name paper towels over generic paper towels, because the brand name offers more absorption," says Aaron Kesselheim, director of the Program on Regulation, Therapeutics, and Law at Brigham and Women's Hospital in Boston. 

"But I don't think there is a compelling reason for patients to think about generic drugs in the same way as generic paper towels."

When buying over-the-counter meds, just buy the cheaper store-brand generic. That's the unanimous consensus from the research and the experts. In every way that you care about, from effectiveness to safety, the store brand by law must be the same. For a generic drug to make it from the factory onto the shelf at CVS or Walgreen's, it absolutely must meet the FDA's following 6 conditions:

  • contain the same active ingredients as the innovator drug (inactive ingredients may vary)
  • be identical in strength, dosage form, and route of administration
  • have the same use indications
  • be bioequivalent
  • meet the same batch requirements for identity, strength, purity, and quality
  • be manufactured under the same strict standards of FDA's good manufacturing practice regulations required for innovator product

The only way that store brands differ from the brand names is their impact on your wallet, not your body. Name brands cost more because they need to offset expenses that generics just don't have to make up for: the costs of running trials, marketing, and advertising. Developing a new prescription drug, which one day may become over-the-counter like Zyrtec or Mucinex, costs at least $2.558 billion, according to the Tufts Center for the Study of Drug Development. 

Bless your heart if you want to donate to those scrappy kids in the pharmaceutical industry, but you won't get more headache-dissolving medicine for your buck and, according to Consumer Reports, you can save as much as 73% by switching to the store brand. "Customers should be reassured that when it comes to the actual ingredients in the pills, that they are the same," says Caleb Alexander, co-director of the John Hopkins Center of Drug Safety and Effectiveness. "Generics offer the same benefit for less money."

This isn't only what experts say; it is what they do. When researchers took a peek into the medicine cabinets of pharmacists, they found that 91% of them bought the store-brand headache medicine. In a 2015 study, researchers found that people who can name the active ingredients in Bayer, Tylenol, Advil, and Aleve, were more likely to buy the generic, which was usually about 40% of the price of the name brand. Pharmacists, who, no shock here, were among the most knowledgeable about the ingredients in these medicines, were also overwhelmingly more likely to choose generics for themselves and their families.

But there must be some rare exception to the buy the store brand rule, right? Well, if you've read this entire article and you're still sliding into VICE's twitter mentions to comment that we're idiots and the store brand is better, then there is some evidence that your belief itself is what will make a pill more effective for you.

Since the 1950s, we have had evidence that the placebo effect can relieve pain. That seems especially true if people think their medicine is expensive, a psychological quirk that not only makes headaches heal faster for some people but also makes wine taste better. Take a 2010 study by psychologist Dan Ariely and his colleagues. They gave volunteers electric shocks and, after they were buzzed, everyone got a pill that they were told was similar to codeine. It wasn't; all of the pills were plain old sugar. But some were told their pill was expensive, while others were told their pill was discounted. You can probably guess what happened: Those who thought they took an expensive pill reported significantly more pain relief. So while there's no difference at a molecular level between the brand and generic, there may be a difference at a psychological level.

"Some medications work because we want them to work," said Niteesh Choudhry, an associate professor of medicine at Harvard Medical School. "But this may be limited to pain or symptom-based medication, as opposed to cholesterol or diabetes. I can't will my cholesterol to go down."

But for everyone else, do as the pharmacists do and save your money. "If you are making a choice," Choudhry said, "I'd take comfort in the fact that generics work just as well."

Photo: AndrejTer/iStock/Getty Images Plus