The Truth About Generics
BY SUSAN J. GROMACKI, OD, MS, FAAO

Do you prescribe generic lens solutions to 30 percent of your patients? Is one out of every four starter kits you dispense labeled with a store name such as Kmart or CVS? Of course not.

Why, then, are our patients purchasing generic products at a high rate? In a word, price. Are they getting the best value for their dollars? Do they know what's in the generic bottle? Do you?

What's in the Bottle?

All generic solutions aren't the same. In fact, they're not necessarily the same as name-brand products, or even another bottle of an identically labeled solution. Every year or so, a retailer entertains bids on which company will produce its private-label solution. When the contract expires, the formulation may change. With expiration dates typically 18 to 36 months into the future, two different formulations could reside in bottles sitting side-by-side on the supermarket shelf.

A single retailer also can purchase more than one formulation. For example, CVS sells both Opti-One (Alcon) and a solution similar to Aquify (CIBA Vision). Meijer, meanwhile, currently sells only a solution similar to Aquify — but in different-colored packages placed next to the corresponding name-brand product on the shelf. The green-labeled box, for example, claims, "If you like Opti-Free Express, try me." Although legal, only the savviest patient understands that the active ingredients in Aquify and Opti-Free Express (Alcon) are completely different.

Clinical significance: When suspecting solution hyper-
sensitivity or incompatibility, look at your patient's bottle so you can read the active ingredients and ascertain if solution is playing a role.

Because contracts generally go to the lowest bidder, most generics contain older formulations. An exception to the rule is Aquify (Table 1). 

Oldies But Goodies?

Older formulations have been and are perfectly fine. But trouble can happen, for example, in that neither ReNu MultiPlus nor Opti-One is FDA-indicated for use with silicone hydrogel contact lenses. Although some older solutions may cause some asymptomatic corneal staining, the newer, premium products are associated with fewer of these observations.

Clinical significance: For silicone hydrogel patients, dispense samples of only those solutions that are indicated by the FDA for use with silicone hydrogel lenses. Carefully instruct patients that no substitutions are allowed.

Prescribe a Solution

We've made great advances in solutions over the past few years; the patient who buys generic often isn't benefiting from that technology. The challenge is communicating that to patients.

Dispensing a complimentary care kit of your preferred solution is a good start. Some practitioners reinforce this by "prescribing" it on a prescription pad; others provide detailed handouts while others review the advantages of these products. Whatever you choose, communication is the key to ensuring that our patients are using what is best for their eyes. CLS

Dr. Gromacki is in group practice in Burke, Virginia, and has served as a faculty member at the University of Michigan Department of Ophthalmology and Visual Sciences.