I previously worked for a prescription claim processor and can answer this.
The unique thing about the Drug market is there are no knockoffs. A "Brand Name" drug in the USA has the _exact_ same active ingredients (and sometimes inactive, take inhalers) as the Generic. Even more hilariously, most drug companies will create a "generic" version of their drug as well as a "branded" because they can sell the same exact thing at a higher price point.
And yet my mother is 100% convinced that the generic of a drug gives her chronic headaches while the "brand name" version doesn't.
If I'm not mistaken, the formulation could be wildly different as long as they match kinetics, yield, and safety profiles set by the FDA, and an individual may have some issue with one formulation over another.
The FDA certifies the entire formulation, which includes everything from the binding/filler chemicals, anti-caking agents, the pill coatings, and even the ink used to mark the pill (which is why imprinting is very popular).
What you're referring to is the ability of a pharmacist to substitute one drug for another, if for instance it wasn't on your insurance's formulary (list of drugs they'll pay for). Drug A may be slightly different than Drug B, but the Drug B your insurance will pay for. Drug B might also _just happen to be_ a generic (because the pharmacist is trying to get your the best deal for your money). There's guidelines from the FDA, DEA, the state insurance commissioner, and state laws the pharmacists must be aware of so it varies greatly between states on what they're allowed to do. Made for a fun rules engine to implement in software.
Doctors can mark a prescription as DAW (Dispense As Written) which then the pharmacist can make 0 substitutions. Insurance companies aren't usually a fan of said doctors.
"The FDA certifies the entire formulation, which includes everything from the binding/filler chemicals, anti-caking agents, the pill coatings, and even the ink used to mark the pill (which is why imprinting is very popular)."
Sometimes the FDA certifies a dosage of a generic based on a different dosage. This caused a problem not long ago when the dosage they assumed was fine didn't dissolve right, hence the absorbed dosage varied and was sometimes way too low. To add insult to injury, it was a psychotropic drug, so everyone assumed patients complaining were "just imagining things" for a long time.
Parent comment states active ingredients are the same, but the "non-active" ingredients can be different. So there is the possibility that something is different in the generic that could cause a reaction.
I've had to use transdermal medication (patches) before, and one of the inactive ingredients that changes is the adhesive, I've noticed that the "brand name" version didn't cause skin breakouts, and the generic did.
That’s not entirely true when talking about auto-injectors that may or may not have needle hiding mechanisms, convenient form-factor, simple or well-known operation, or voice narration (auvi-q).
I am a parent of two young children with tree nut allergies, and I strongly prefer the Auvi-Q despite them gouging my insurer/employer. I use the generic epi-pen for school and child care since that’s what teachers are familiar with.
List price for Auvi-Q is around $5000 an injector. I carry _four_ of them everywhere I go. It’s utterly ridiculous for a dose of medicine worth less than $2, but when I need to use one I’m glad I’m not using a syringe or more complicated off-brand.
Are you misunderstanding that the ‘medical devices’ I was referring to are just like the Epi-Pen, and pre-filled with epinephrine for one-time use? I assume your reference to inhalers was to drugs similar to albuterol that include aerosol delivery ‘devices.’
The unique thing about the Drug market is there are no knockoffs. A "Brand Name" drug in the USA has the _exact_ same active ingredients (and sometimes inactive, take inhalers) as the Generic. Even more hilariously, most drug companies will create a "generic" version of their drug as well as a "branded" because they can sell the same exact thing at a higher price point.