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Comment by moksly | Hacker News Reader

Do doctors prescribe brands in America? Here they’ll prescribe you with the working substance, and unless it’s still patented (which most of them aren’t) then you’ll just get offered the cheapest brand at the pharmacy by default.

I guess commercials would still work if you branded yourself hard enough, but our culture is more like the Velcro thing, where when people ask for a “panodil” or a “pinex” they don’t really care if it’s actually a panodil or a pinex as long as it’s a headache pill with that the same sort or working chemical.

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They often prescribe brands in the sense that they will literally write the brand name in their own hand on the prescription, and that is technically literally exactly the prescription. However, the pharmacy can substitute a perfectly equivalent drug on its own recognizance based on the doctor's prescription, but the distinction seems to technically exist. (The pharmacist position takes a lot of study and licensing as well.) I believe a doctor can or could write "no substitutions", but things aren't quite bad enough that a doctor would risk their license to do that to bolster sales for a brand or block a patient from receiving generic medication--they'd need some kind of concrete reason, like knowing or suspecting a patient is allergic to an inactive ingredient. (It's all theory, because our doctors are overworked and would never pay that kind of attention.)

Pretty sure insurance companies have it down to a science to cover all cheap generics over brand name and through you through bureaucratic hell with pre authorization forms until you are beaten into submission to take the cheap version (more $$$ for insurance company)

Sometimes they do, but often they tell the pharmacy that they can use the generic (and most folks seem to want generic). Occasionally, they insist on the brand, but this is more often because while most generics are the same, sometimes there are differences. Lithium, used as a mood stabilizer, is the example I can think of, but is far from the only one.

More people want brand name for over the counter - like panodil/pinex - but sometimes this is because folks don't realize that the generic is the same drug.

For some specialised conditions in the UK - they actually do prescribe exactly the brand/version.

For my posttransplant meds some of the are explicitly "must" be this version. Also some meds (anti rejection) are dispensed direct from the hospital

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