Prescription Problems: Not what the doctor ordered

BOSTON — It's common to be switched from a brand-name drug to its generic version, but now insurance companies are engaging in a new kind of switch at the pharmacy called “therapeutic substitution."

The insurance companies say it's a safe and effective way to save money. But Boston 25 News talked with several local patients and doctors who raised concerns.

Marathon bombing survivor's debilitating pain

Lynn Crisci suffered intense migraine headaches after surviving the Boston Marathon bombing in 2013. She was sitting at a café, just 30 feet away from one of the blasts.

“I saw the entire thing go up five stories high and then nothing. People just disappeared into it,” Crisci told Boston 25 News.

To stop the pain, Lynn's doctor prescribed the drug Sumatriptan.

“I just hand it to the pharmacist and it's their job to put the right pills in the right bottle whatever it is,” Crisci said. “It just never occurred to me that this was not what my doctor prescribed.”

Lynn says she and her doctor didn’t know that the medication the pharmacist put in the bottle was not Sumatriptan, but a similar compound called Naratriptan.

In the "triptan" family of drugs, it is the only one, Lynn later learned, that her insurance will pay for.  She took it, and for two years, her pain raged on.

“The switching, the saving money, that's business, okay? But how are they not required by law to tell you you got switched?” Crisci asked.

How Therapeutic Substitution Works

Therapeutic substitution is based on the belief and the clinical evidence that different drugs in the same drug family should have similar enough effects, that it's safe to interchange them.

And one expert tells Boston 25 News, in the majority of cases the switch makes no therapeutic difference.

“Ninety-five percent of the time the product that the insurance company is suggesting will work. But that other 5 percent of the time it won't work,” said Todd Brown, RPh of Northeastern University.

Complication concerns

New Hampshire resident Doug Habecker worries that therapeutic substitutions could lead to serious complications. Thirty years ago, Habecker experienced a severe drug side effect -- a skin condition known as Stevens-Johnson syndrome.

The possibility of Stevens-Johnson syndrome is always on Habecker's mind, especially when prescribed a new medication.

“I'm extremely careful. I research anything before I take it,” Habecker said.

That research led to a confrontation earlier this year with his insurance company when the company tried to change the insulin he uses, Novolog, for a very similar insulin, Humalog.

“Historically, eight patients have had Stevens-Johnson as a result of Novolog. Thirty-eight have had it as a result of Humalog,” said Habecker.

After a month of paperwork and phone calls, his insurance finally agreed to cover the Novolog. But his co-pay went up $20.

Insurance Industry Response

Massachusetts insurers told Boston 25 News, though cost matters, it is hardly the only variable with therapeutic substitutions.

“We're looking at: what's the data that's been sent to the FDA? How did the FDA approve the drug? What's the underlying safety and effectiveness to make sure that they're comparable. So I wouldn't say that any two drugs in the same family can be switched,” said Massachusetts Association of Health Plans President Dr. Neil Minkoff.

Tips for Consumers

But with therapeutic substitutions likely to grow, one pharmacist told Boston 25 News it’s important to be an educated consumer.

“They should know what the medicine is, why they're taking it and how should they be taking it,” said Todd Brown, RPh of Northeastern University.

“I always check the labels on my medications. I check to see who the manufacturer was and  how it's labeled and if the pills look the same,” said Dr. Hank Dorkin, President of the Massachusetts Medical Society.

Lynn Crisci learned that lesson the hard way. She's now taking her original prescription, Sumatriptan, and her debilitating pain went away.

“For someone who was begging, begging for someone to help her die, this is a miracle.”