Just as good?

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Expanding market

Currently, 64% of all prescriptions filled in the United States are for generics. That percentage is expected to rise steeply over the next few years.

In 2007, the FDA approved manufacturers' plans to market 682 new generics in the United States. The agency still is working its way through a backlog of about 1,300 more applications from generic pharmaceutical manufacturers -- a tally that grows weekly. Among the widely prescribed medications expected to appear in generic form in the next few years: the migraine drug Imitrex; the cholesterol drug Lipitor; the blood pressure drug Norvasc; the gastrointestinal reflux drug Prevacid; and the psychiatric medications Risperdal, Effexor and Zyprexa.

At the same time, consumers are finding themselves constrained by their health plans, or lack of one.

In 2000, 22% of American workers with employer-sponsored health insurance had plans that made no distinctions in their coverage of medications: A patient's co-payment was the same whether she chose the expensive brand-name or the generic formulation of a drug.

Today, only 6% of workers have prescription plans with such free choice, reports the Kaiser Family Foundation, which conducts an annual survey of employer health benefits. Kaiser's survey shows that more insurers are making more distinctions among medicines for which they will help pay and, in most cases, asking workers to shoulder a higher proportion of costs for drugs that cost more.

Most patients welcome generics enthusiastically. Retail giants such as Wal-Mart and Target have begun filling most generic prescriptions for prices as low as $4 apiece. Generic drugs cost between 30% and 80% of the brand names they mimic, and price tags on those pioneer medicines are headed upward. Wholesale prices for the top-selling 50 brand-name medications rose by about 8% in 2007, according to a report by Delta Marketing Dynamics, which tracks drug trends. That's after hikes of about 7% in 2006 and about 6% in 2005.

At the same time, Medicare, Medicaid, private insurance companies and hospital pharmacies are trying to hold down rising costs by aggressively encouraging patients to use generics. Increasingly, many are going further: They are asking patients to switch to a different class of drugs to treat a condition -- say, from an ACE inhibitor to a beta blocker to control high blood pressure -- because more generics may be available in one drug class than another. Such "formulary switches" can be more problematic than a brand-to-generic switch, because the old and new drugs work differently.