As use of prescription drugs climbs exponentially, many Americans are struggling to cope with the costs.

The situation would be even more dire without legislation passed in 1984. The Drug Price Competition and Patent Term Restoration Act allowed companies to sell generic versions of brand name drugs after patents expire. On average, generics cost 30% less than name brands.

"Without the original research and development costs, prices are much lower," says pharmacist Jim Obrecht.

In 1984, only 19% of U.S. prescriptions were for generics. Today, 65% of prescriptions are generic.

Obrecht owned pharmacies in Ames and Huxley, Iowa, for 40 years. Today he works part time at two rural, locally owned pharmacies.

"Insurance companies no longer pay for brand name drugs, in most cases, and if they do, the co-pay is higher," he says. "But pharmacists are required to inform patients that a generic is being substituted."

A generic drug often differs in color, taste, or shape. Companies must prove to FDA that it has the same bio availability as the brand and that it's absorbed into the body with no more than a 10% difference.

However, some generics may not be advisable for certain medical conditions. In these cases, small changes in dose and/or blood concentration could cause clinically important changes in how the drug works.

One such drug is Coumadin, a blood thinner. Switching to a generic could thin blood too much (causing bleeding) or not enough (raising the risk that a clot could form).

"It may not be advisable to switch to a generic," Obrecht says. "The body may react differently."

Similar concerns apply to certain cardiac, thyroid, or epilepsy drugs.

Although generics are less expensive, a 2006 Consumer Reports survey of five common generic drugs revealed large variations in markup. Capsule or tablet prices may differ for the same drug; a 90-day supply typically costs less than 30 days.

The Consumer Reports medical guide Web site reviews more than 1,000 brand name and generics. A secure page lists U.S. average prices.

Several national chain stores have cut generic prices dramatically. "Your pharmacy may not be able to match their lower prices," Obrecht says. "It's a tactic to get people there to buy other products. Good rapport with a local pharmacist is worth a lot."

About 19 states offer prescription drug discount programs. Drug companies also provide low-cost or free drugs. Ask your pharmacist for more information.

Many hospitals and care facility medications are unused. In 2005, the Iowa Prescription Drug Donation Repository began accepting drug donations in sealed, original packaging or sample doses. Approved pharmacies and facilities distribute these donations. Other states are studying similar programs.

During the next two years, about 100 drugs will lose patent protection, and generics will grow. "Companies are even making generics of their own brands so they won't lose market share," Obrecht says.