Why don’t a lot of people use generics?

One of the big things I don't see mentioned here is that while the "active ingredient" in the medication is the same, all the other stuff in it is not. This also includes the binding agents that hold the med together and also the release mechanisms that control how/when the medicine is absorbed into your body.
For example, generic extended release amphetamine salts don't release into your body in the same way Adderall XR does, despite being the same medication. While the patent on the drug has expired, the patent on the proprietary release mechanism has not expired. So generics can't copy it. This could cause the generic to not work as well for some people, or some people could have a reaction to those different ingredients.
Edited: fixed spelling
- I was going to say, it does depend on the drug and person. My son had that experience where the insurance flip-flopped to cover generic instead of Adderall, but it did not work at all for him so we had to fight to get it changed back. Since then every year or so insurance plays their game and we have to go through the ritual explaining why it can't be generic when that becomes the one covered. It shouldn't be this hard, right?
  
  Omg. We fight the damn battle every year as well for our son. They don't understand that the delivery systems are different. Well, they probably do, but don't care.
- I think it's generic and not genetic 🧬
  
  SwiftKey auto correct strikes again. Fixed
- I'm literally reading this while my wife is coughing from a generic brand inhaler.

Because I use a real programming language, tell me what a T is and I'll start caring
- It's whatever you want it to be!
- The point of T is that you don't have to care
- What you don't like to deal with this mess? https://en.wikipedia.org/wiki/Covariance_and_contravariance_(computer_science)
  
  "Jokes on you, I'm into that shit" Skeletor voice
- Obligatory fuck java generics.

It’s rare, but some people do have adverse reactions to generics, and have to use the name brands.
- Generic thyroid meds are notoriously poorly tolerated.
  
  This is incorrect. You just can't switch manufacturers easily if you're stable on one. But that's not a brand vs generic thing, that's an any manufacturer to any-other manufacturer thing. Same with warfarin, narrow-therapeutic index antiepileptics, etc.
  
  Yup. I've gone unmedicated for 10+ years as a result. I'll take the highs/lows of hashimoto's over ending up in the ER with my heart pounding out of my chest any day of the week.

In addition to the reasons other people mention, placebo is a helluva drug. If you believe the name brand is better, it may actually become more effective for you even if the active ingredients are the same as the generic.
- Name brands only matter to me when it comes to chips, soda, cereal bars (like nutri-grain), and shampoo. Maybe some others I'm not thinking of. But drugs are def not on that list. The only time I ever requested name brand drugs was when I got a script for Klonopin I didn't need back when I was an addict and only because I thought it would be cool to have the pills with the little K cut out of the middle, because like I said, addict.
- This is why I prefer Advil liquid gels. I've had plenty of generic ibuprofen. I'm convinced that Advil is faster acting with 100% efficacy.
  
  Liquid gels are absolutely faster acting than compressed powder. I buy both generic naproxen pills and name brand Aleve liquid gels so that I have two different available delivery mechanisms (and unit prices) for the same active ingredient, and I choose which to take (or to give my dependents) based on the circumstances at the time of use.

It all depends on the generics. I buy generic cereal. But only certain ones because other ones I have tried aren't the same as the name brand and I like the name brand. Sometimes it's as simple as texture difference or a difference in flavor.
In the case of my epi-pens, the generic injectors don't work exactly the same and that can be a bit much in an emergency where your throat is swelling shut or you're having difficulty breathing.
In the case of something over the counter, I'd still wager things like mouth feel, smell, or other sensory factors are a reason. Like for instance, I prefer the smooth coating on Advil to the matte coating on Motrin or other ibuprofen generic meds.
- Same here (in terms of general approach, though I can't buy generic cereal anymore, need that gluten free logo).
  There was a vast difference for me in generics of omeprazole, and the first few generics of dexlansoprazole. Not as critical as an epi-pen obviously, but the delivery mechanism for pills can be so different it absolutely makes a difference.

The generic Advil don't have the candy coating.

I grew up in a poor household, relative to the other kids I went to school with. While I was in public school, I was bullied for not wearing name brand clothing and because all of my school supplies and snacks and everything was generic brand. I became extremely self-conscious about it, and was always trying to hide what I had, or if I found name brand packaging for something in the trash or on the floor, I'd grab it so I could repackage my stuff and pretend like I totally had name brand stuff. As a young adult when I went to college, I only ever aimed for buying name brand stuff, but it was really hard to do so, considering I was still broke...
Anyways, I eventually matured a little more and realized kids are cruel and the whole thing was dumb. I exclusively go with generic everything now and am, always trying to get the best deal, and I even went back to buying second-hand clothes, cause why not?
All that to say, maybe some people had similar experiences and just never grew out of it.

In fact, I do prefer to buy generics. There are dozens of us!
- I'll gladly buy some generics but I am firmly on brand name stuff with some types of cheese... especially preshredded. I got some generic cheeses in the past that were basically flavored plastic

Not to be super-pessimistic but the pharmaceutical industry seems to based upon encouraging awareness and promotion of name brands. Advertising and incentivizing doctors to prescribe promotes a system where the average patient has a hard time understanding and navigating, especially where the patient wants the best opportunity to treat a significant impact to their wellness.

I'm guessing it's because of concerns about quality control.
- For example, I used to use generic eye drops. Then there were a bunch of recalls on eye drops made in India because they weren't kept sterile and people were getting eye infections. So now I make sure to only buy eye drops that are manufactured in countries with actual controls on health codes. It turns out that imposing that restriction elliminated all the generic options. I'm certainly not happy to be paying double for brand name pataday, but I don't care to mess with the chance of eye infections.

For the most part, I choose the generic version for pharmaceuticals where available, but there are a few exceptions. For example, for something like a nasal spray, the generic version's dispensing mechanism may be inferior?

In Canada we have generics and we still scare smoothbrainers about how the generics will give you a shitty ass compared to the full Branded version just to keep them in the ecosystem
And then we make it so you can't fill all your prescriptions on the same day, so now you gotta set calendar reminders for when each one is due for a refill

Many generic meds are made in filthy factories with no quality control.
https://www.bostonglobe.com/2024/06/17/metro/dozens-of-cvs-generic-drug-recalls-expose-link-to-tainted-factories/
The FDA is slacking on testing generics for quality assurance, but third parties and other countries are revealing problems.
https://www.forbes.com/sites/arthurkellermann/2024/01/10/we-should-test-generic-drugs-to-assure-safety-the-fda-hates-the-idea/
https://www.statnews.com/2024/08/12/fda-withdraw-approval-400-plus-tainted-drugs/
- It's interesting that you put the blame on the FDA. I'm not in the USA, but the effectiveness of a body like the FDA, the FCC, the EPA, FAA and all the others is directly related to how much money they have available and who is running the department; these are determined by politicians.
  In other words, medical oversight depends entirely on whom you vote for and why voting is important. It's the "little" things like this, not the defence or education budgets capturing the headlines that make the difference.

Though there are in some cases specific reasons to use certain brands, its usually just due to marketing, branding, and near total ignorance.

In Denmark the pharmacies are required to offer the genetic version. I generally take it. I know that a lot of elderly can get confused if their medicine changes, so that's one reason for choosing the brand name.

Where I live (Germany), it's fairly common to buy the generics. Not everyone does it, but enough people. They're available and oftentimes it's the exact same ingredients inside, just a different packaging and brand name on it. And a third of the price or so. I think it's more that people buy what they're used to. And if you just ask for Aspirin (which is a brand name here), the pharmacist is going to hand you that, and not the generic. So it's a bit more effort to add half a sentence to deliberately ask for the cheap one.

My mom had medicare and a good secondary. Looking back, i should have requested name brands for her. With generic, there are often a couple of different patterns (size, shape, color) that you get and it makes it really difficult for older people to take their meds correctly.

Their reasons will remain a mystery. If they don't want to tell you, you'll just never know.
As for me, I use generic medications whenever I have to pay for it out of pocket. If insurance covers it, I'm not putting in the effort to make sure I get generic.

Perception that the generic brands don't work as well or are lower quality. I had a co-worker who maintained that the generic version of his prescription drug didn't work at all for him (this was back when France passed a law that is generic version of your medicine existed, the branded version wouldn't be fully covered by the state health insurance, so lots of people were complaining about them)

- I actually like typescript generics, but I find myself actually writing them relatively infrequently

There is significantly less oversight on generics vs brand. As a medical provider I have seen numerous examples of generics not working nearly as well as brand and I have switched patients back to brand. YMMV.

Training

Doesn't it kinda depend on what the doctor writes on the prescription? I've had both doctors who just put the brand name on there but also doctors who insist on writing down the generic version.
Either way, I don't really see any point in arguing with them about whichever one they prefer? The medicines generally do work the same.
- The pharmacy can give you a generic no matter how the doctor writes it.
  
  I just want to jump in to say this is probably dependant on where you live or which pharmacy you go to. In my state, if the doctor writes for the brand name, the pharmacy MUST fill the brand name. They can call the doctor to get approval for the generic, but they won't just fill the generic at the patient's request. YMMV

People don't? The only drugs I use are generics, where I live they usually cost half the price or less and work just as the original does, I've never had problems so this is news to me. Maybe things are different elsewhere?