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Comment by LeifCarrotson | Hacker News Reader

Drug salespeople, doctors, pharmacists, and insurance companies.

If you get a prescription for a ProAir HFA inhaler, which is parented because it uses R134a, even if you did want to do your own research and evaluate whether the generic with the different propellant would work you can't just go buy the generic, you have to do extra work to get a prescription that applies.

Doctors don't write prescriptions for albuterol sulfate, they write ProAir HFA and it's up to the consumer to push back. They don't even advise taking OTC ibuprofen or pseudoephedrine, they say Advil and Sudafed. It's a pet peeve of mine, but it seems I'm the weird one in that respect...

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In Canada pharmacists will generally just ignore brand names written by MDs and fill with generics unless there’s a known difference or the patient specifically asks (and is willing to pay more).

It’s similar in both countries with some slight variation in the US depending on the state.

Unless the prescription is marked as “do not substitute” pharmacists generally have the discretion to substitute for a generic, in fact a few states require it.

If you don't need to be able to carry it around, albuterol solution is still cheaply available for nebulizers - but you'll need a nebulizer (which isn't portable) to use it.

ProAir HFA is one in which the legally permissible substitutions by the pharmacist are limited, largely because the old propellant (and thus generics based on it) is not legal for sale.

We use trade names because they're shorter and easier for patients (and doctors) to remember. Outside of a few specialized areas - epilepsy, warfarin, thyroid hormone - very very few doctors use branded products when a generic is available (and there's nothing wrong with the generics there, except that you need to get the same product every time to titrate the dose, and unless you know that X pharmacy will only stock the drug from Y manufacturer, it's a crapshoot).

In the US if a doctor prescribed a brand name, the Rx works for the generic as well. For me, it usually happens automatically at the pharmacy with no action on my end.

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