Medicine prices are sky high—but is it always a good idea to go generic?

Let’s face it: Medicine has never been more expensive in the U.S. than it is right now. The AIDS medication Daraprim jumped from roughly $13 per pill to $750 per pill in 2015, and the life-saving EpiPen now costs $600 per two doses (and the manufacturer is being sued over it). The problem has gotten so intense that Congress passed two bills in October aimed at making drug pricing more transparent up-front.

Of course, the tried-and-true advice for saving $$ on meds: Shop generic when you can. Generic drugs (as in, the acetaminophen to your Tylenol) generally cost about 80 to 85 percent less than their name-brand counterparts, according to the FDA. But when it comes to your health, is going generic the equivalent to buying a knock-off designer bag: looks the same, costs less, but is made with inferior materials?

Not quite. “Many people assume that brand-name medications are ‘better’ because they cost more, and because of brand recognition,” says Michael Grosso, MD, chief medical officer at Huntington Hospital. But, he adds, there are a lot of people out there who are all about generic drugs. And for good reason: “Federal oversight by the FDA has increased at all levels of manufacturing of generic drugs,” says Alan Mensch MD, FACP, FCCP, the senior VP of medical affairs at Plainview & Syosset Hospitals—making the drugs safe and generally just as effective as name-brand ones (no cheap leather or shoddy stitching here). “More than 80 percent of the drugs purchased in the United States are now generics,” he adds.

But as for truly understanding the diff between name brand vs generic drugs (beyond the price tag)…well, that’s when things get a little bit more complex.

Is there really a difference?

It depends on what you’re looking at. In terms of active ingredients, the FDA mandates that generic drugs contain the identical active ingredient as the brand name counterpart, Dr. Mensch says. They also are supposed to have the same strength and dosage as the brand-name version as well as the same “route of administration” (meaning that if the name-brand drug is a pill you take orally once a day, the generic must also be a pill that’s taken orally once a day). The goal is to ensure that generics work practically the same as their brand-name counterparts.

But like how In-N-Out will never just hand out their animal sauce recipe, these name-brand companies aren’t about to release the exact formula for their drugs. (Ya know, because capitalism—those formulas are valuable.) This means that the filler ingredients in the generic version of the drug may be different, Dr. Mensch says. But those filler ingredients—mostly things like colors, flavoring, and inactive ingredients—shouldn’t affect performance, he adds, so it’s not usually a huge deal that they’re a little different than what’s in the name-brand drug.

“Generics are subject to the same FDA oversight as brand name medications, and the same standards of potency and purity.” —Michael Brosso, MD

“The FDA also requires that generic medications are manufactured with the same strict standards as their brand name counterpart,” says Dr. Mensch. “The FDA conducts more than 3500 inspections of manufacturing plants to ensure generic drugs are bioequivalent.” (Bioequivalent = when two drugs have the same result.) Meaning that generic treatments are just as legit and safe as the brand-name versions.

And in case you had any remaining hesitation: “Generics are subject to the same FDA oversight as brand name medications, and the same standards of potency and purity,” says Dr. Grosso. Studies back this up.

So then if they’re the same thing…why are generics literally 80 percent cheaper? Basically, they don’t have to repeat all the expensive clinical trials that name brand drugs had to do, according to the FDA (so it costs less to make them). Their existence also helps drive competition in the market, making all drugs a bit cheaper since there are more options to choose from.

Are there any instances where you shouldn’t choose generic medication?

“Occasionally, there are slight differences in drug delivery, especially for long-acting preparations,” Dr. Grosso explains. “This can make a difference for a small minority of medications, but the prescribing physician will specify the brand-name drug when this is a consideration.” An example of this would be some ADHD medications, but again, this is not super common.

To ensure you don’t get gouged at the pharmacy check-out, always ask your doctor if there are any generics available for a drug they prescribe you—especially since some insurance companies can be a little iffy about covering name-brand drugs when a generic is available.

Generally, physicians like Dr. Grosso and Dr. Mensch will recommend generic medications to their patients because they are just as effective as brand name, and they’ll save you a lot of money. So yeah, there’s officially no shame in using the Target version of Tylenol.

Speaking of drugs, are psychedelics about to replace your depression medication? And here are the things you need to ask your doctor before starting a new mental health medication.