Home > Health, July 2009 > Transplant Meds – Brand vs Generic

Transplant Meds – Brand vs Generic

As many of you transplantees may already know, CellCept is now available in generic, and Prograf has lost patent protection (although I’m not aware of any generic versions yet; correct me if I’m wrong).

I discussed this with my transplant surgeon at my last appointment (BEFORE I found out I had BK virus and was taken off CellCept). He said he preferred me to take brand CellCept, but that if my insurance didn’t cover it, I’d have to take generic.  I pressed him as to whether there is an appreciable difference between brand and generic, and he eventually said “no”, but that he preferred I’d take the brand.  (huh?)

I discussed this with a pharmacist I work with, and he explained that in some drugs, if there’s a narrow therapuetic index (the difference between therapuetic and toxic), then it may be an issue, but with CellCept, it shouldn’t be an issue.  (I hope I got that right)

Anyway, I had read somewhere on an internet forum that there may be up to 15% variability between brand and generic as allowed by the FDA, but this is apparently FALSE. Given that there is only a low single digit difference between the 2, it’s not a concern, especially as there are OTHER factors with absorption, such as interference from foods and minerals. In other words, your drug levels will be pretty close each time you take a med, but never exactly the same.

I plan on taking generic when I’m back on CellCept.  My rationale:

  • My insurance has a “lifetime limit” of drug coverage. By taking the lower priced med, I will reach that later rather than sooner
  • I have periodic ICF’s (Immune Cell Function) done; this should pick up on any problems

For those who will stay on brand CellCept, here is a link to some help with co-pays (unless you are on Medicare or Medicaid):  click on “Click here for details” at the CellCept for Living website.

For those on Prograf, check out the Prograf Value Card program.

Thoughts on this?

  1. August 8, 2009 at 7:32 am

    Sorry to hear you got the BK virus. Hope all goes well.

    Most docs seem to be saying the same thing. Stay with the brand. I’m on myfortic so I didn’t bother to ask, but my friends were all told to stick to cellcept. One guy though, because of financial issues was ok’d to go generic, but was told to have his labs done more regularly after as well as check the mmf levels.

    • August 8, 2009 at 6:33 pm

      Thanks; I think everything will be fine. I’m just thankful that my Transplant Center routinely screens for BK so that it’s caught before damage could take place.

      I don’t have financial issues with meds (I’m very fortunate to have an excellent HMO that actually places emphasis on prevention, as HMO were intended for). I’m still getting monthly labs 15 months post-transplant, as well as an ICF (Immune Cell Function aka ImmunKnow by Cylex) every 3 months. I have awesome Transplant Surgeons!

  2. August 10, 2009 at 7:20 am

    Cool. That’s good to hear.

  3. August 11, 2009 at 4:14 pm

    I wish ICF would be here and approved for our little guy, but his local nephrologist said it will be a long long time before it is approved for kids. I figure by that time he will be an adult.
    We actually spoke with our transplant Center last month on this same thing because our pharmacist mentioned it to us and she wanted them to be prepared for any potential changes if they occurred. They told us at the center that they would do anything and everything in their power to keep him on the brand name, but we may have to switch anyways. That being said the Center recently received a HUGE research grant from Roche Pharmaceutical for pediatric renal transplants (hmmmmm.) 😉

    • August 11, 2009 at 7:56 pm

      The doc explained the rationale of how ICF works. It has something to do with checking ATP levels (it’s been awhile since A & P; don’t ask me to explain it) 🙂 Over suppression of the immune system results in low ATP levels. The goal is around 200; mine was 78 at it’s lowest (which is how I believe I got the BK virus flare up).

      I’m not surprised it’s not available for Pediatric Transplantees. Many of the meds given to children aren’t FDA sanctioned officially, since testing is mainly in the adult population. Thus, Pediatricians usually use studies to determine what is to be used, the dose, etc, because clinical trials may not have been done.

      I believe there are several reasons for use of brand: some docs believe that the insurance companies should be forced into covering brand (I’ve seen it professionally), some are swayed by research grants I’m sure, and others are fearful that a generic may not be as effective for whatever reason.

      • August 12, 2009 at 12:12 am

        They told us “that there was a chance the concentration would be too different and cause problems. Derek has been a picture perfect example of how they want a transplant to go for a child and don’t want to change a thing.”

  4. January 28, 2010 at 2:13 pm

    There is a generic for Procraf that has just been approved. I haven’t tried it yet, but plan to when I need a new refill. Didn’t know there was a generic for Cellcept. Thanks for the information. Does anyone know the cost of either of the generics? With and without insurance.

    • January 28, 2010 at 9:19 pm

      I don’t know the price of either generic. The insurance price would depend on your specific plan.

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