Increasing demand while decreasing costs of generic medicines

Generic medicines: perceptions of consumers in Melbourne, Australia

Objective

The objective of this study was to explore consumers' perceptions and opinions of generic medicines and to identify barriers to their use of generic medicines.

Method

A qualitative approach was used. A purposive sample of consumers, aged 22–80 years, living in the Melbourne, Australia, metropolitan area were interviewed using a semi-structured interview guide.

Key findings

Sixteen consumers were interviewed. Thematic content analysis of the interviews identified four major themes: knowledge about generic medicines, acceptance of generics, non-acceptance of generics, and education needs pertaining to generic medicine use. In terms of knowledge, some consumers were not familiar with the term ‘generic medicines’, but were more familiar with the term ‘cheaper brand of medicine’. The major reason for acceptance of generic medicines among the consumers interviewed was cost. Positive encouragement from the healthcare providers was seen to influence generic medicine uptake by consumers. The major barriers to acceptance included influence from medical practitioners, side-effects from generic brands, and confusion that may arise from using different brands. To encourage future uptake of generics by consumers, some of the respondents recommended that education strategies be implemented by healthcare practitioners and governmental agencies to educate people on the safety and efficacy of generic medicines.

Conclusions

This study indicated that consumers interviewed generally had positive attitudes towards the use of generic medicines. The findings also suggest that direct patient education by the healthcare providers on issues relating to safety and efficacy of generic medicines could further enhance their uptake.

"This body does not want free medicines": South African consumer perceptions of drug quality

OBJECTIVES Like many other developing countries, South Africa provides free medicines through its public health care facilities. Recent policies encourage generic substitution in the private sector. This study explored South African consumer perceptions of drug quality and whether these perceptions influenced how people procured and used their medicines. METHODS The study was undertaken in Durban, Cape Town and Johannesburg in South Africa between December 2005 and January 2006. A combination of purposive and snowball sampling was used to recruit participants from low and middle socio-economic groups as well as the elderly and teenagers. Data were collected through 12 focus group discussions involving a total of 73 participants. Interviews were tape-recorded. Thematic analysis was performed on the transcripts. RESULTS Irrespective of socio-economic status, respondents described medicine quality in terms of the effect the medicine produced on felt symptoms. Generic medicines, as well as medicines supplied without charge by the state, were considered to be poor quality and treated with suspicion. Respondents obtained medicines from three sources: public sector hospitals and/or clinics, dispensing doctors and community pharmacies. Cost, avoidance of feeling 'second-class', receiving individualized care and choice in drug selection were the main determinants influencing their procurement behaviour. Selection of over-the-counter medicines was influenced by prior knowledge of products, through advertising and previous use. Participants perceived that they had limited influence on selection of prescription medicines. Generic substitution would be supported if the doctor, rather than the pharmacist, recommended it. CONCLUSIONS Our findings emphasize the importance of meaningful consumer involvement in the development of national medicines policies, and strategic campaigns targeting consumers and prescribers regarding the quality of generic and essential medicines. Where consumers perceive free or generic medicines as inferior, this could significantly undermine attempts to implement national medicines policies aimed to improve access to medicines.

Do generics offer significant savings to the UK National Health Service?

BACKGROUND

The UK has traditionally had strong proxy demand-side measures favouring generic drug use, including prescribing guidance, financial incentives and encouraging generic prescribing. At distribution level, pharmacies are paid a salary for their dispensing work, based on volume dispensed, and procure generic products on the basis of discounts given to them by manufacturers or wholesalers. The supply-side has been subject to price regulation, and the recent requirement for manufacturers/wholesalers to report prices net of discounts to the DoH, indicate that reimbursed prices for generics may be higher than commodity level.

OBJECTIVES

To investigate the level of discounts off the Drug Tariff Price made available to pharmacies and, determine whether the NHS could have a better deal than currently from generic drug purchasing.

DATA AND METHODS

Data on net prices were acquired for different presentations of 12 generic molecules selected across different therapeutic categories and included in the 50 most selling generic prescription only products in the UK in the first quarter of 2005. For these products, 31 out of a possible 34 presentations (90%) were surveyed. The data sources were price lists of three leading full-line wholesalers (one national, two regional), out of a possible 11 full-line wholesalers (27.2%), and three leading generic drug manufacturers, out of a possible 15 manufacturers (20%).

RESULTS

Generic prescribing in the selected molecules was 94.6%, above the national average of 80%, and the total net ingredient cost (NIC) was 675 million pounds, of which 607.5 million pounds (90%) was generic. In 20 of the product presentations reviewed (64.5%), maximum discounts exceeded 60%, whereas in seven (22.6%) maximum discounts ranged between 50 and 60% off the Drug Tariff Price. Reimbursed prices for leading generic molecules are significantly higher than their pharmacy acquisition cost.

CONCLUSIONS

The NHS is reimbursing generics at too high prices and a significant proportion of the reimbursed price accrues to the distribution chain in a fashion that resembles an indirect subsidy. The NHS can improve efficiency as well as increase savings, by purchasing generics closer to their market price. This would require changes in the way pharmacies are reimbursed, for instance, by changing the way the clawback is calculated, or altogether abolishing discounts and introducing a fixed dispensing fee; it could also mean introducing transparency in the determination of Drug Tariff prices by the relevant stakeholders. As the cost per generic script is, in the majority of cases, below the dispensing fee, the current reimbursement system for generics results in a re-distribution from patients and the NHS to the retail distribution chain.

The impact of therapeutic reference pricing on innovation in cardiovascular medicine

Therapeutic reference pricing (TRP) places medicines to treat the same medical condition into groups or 'clusters' with a single common reimbursed price. Underpinning this economic measure is an implicit assumption that the products included in the cluster have an equivalent effect on a typical patient with this disease. 'Truly innovative' products can be exempt from inclusion in the cluster. This increasingly common approach to cost containment allocates products into one of two categories - truly innovative or therapeutically equivalent. This study examines the implications of TRP against the step-wise evolution of drugs for cardiovascular conditions over the past 50 years. It illustrates the complex interactions between advances in understanding of cellular and molecular disease mechanisms, diagnostic techniques, treatment concepts, and the synthesis, testing and commercialisation of products. It confirms the highly unpredictable and incremental nature of the innovation process. Medical progress in terms of improvement in patient outcomes over the long-term depends on the cumulative effect of year after year of painstaking incremental advances. It shows that the parallel processes of advances in scientific knowledge and the industrial 'investment-innovative cycle' involve highly developed sets of complementary capabilities and resources. A framework is developed to assess the impact of TRP upon research and development investment decisions and the development of therapeutic classes. We conclude that a simple categorisation of products as either 'truly innovative' or 'therapeutically equivalent' is inconsistent with the incremental processes of innovation and the resulting differentiated product streams revealed by our analysis. Widespread introduction of TRP would probably have prematurely curtailed development of many incremental innovations that became the preferred 'product of choice' by physicians for some indications and patients in managing the incidence of cardiovascular disease.

Changing relationships: attitudes and opinions of general practitioners and pharmacists regarding the role of the community pharmacist

BACKGROUND

Relationship between general practitioners and pharmacists.

AIM

To explore similarities and differences in opinions between general practitioners and pharmacists about the pharmacist's role. To identify factors which determine the attitude of the general practitioner towards the role of the pharmacist as a care provider.

DESIGN

Cross-sectional questionnaire survey.

SETTING

The Netherlands, 2001.

PARTICIPANTS

926 non-dispensing general practitioners, 93 dispensing general practitioners and 328 community pharmacists.

METHODS

Statements about the pharmacist's position in primary care were formulated. The attitude towards the pharmacist's care-providing function was determined by adding the scores to the statements. Data were collected on age, gender, professional experience, trainership, type and size of practice, electronic communication, urbanisation level, part-time work, work pressure, postgraduate training, pharmacotherapy audit meetings (PTAMs), the mutual relationship and the desired role of the pharmacist in pharmacotherapy.

RESULTS

No significant differences in opinions were found between pharmacists and non-dispending general practitioners with respect to a number of the pharmacist's signalling tasks. Eighty-six percent (CI 83-89) of non-dispensing general practitioners and eighty-two percent (CI 76-87) of pharmacists shared the opinion that pharmacists need to provide the general practitioner with feedback on prescription figures. Furthermore, 85% (CI 82-88) of the non-dispensing general practitioners and 80% (CI 75-86) of the pharmacists believed that pharmacists should suggest items for the PTAM agenda, based on prescription patterns they notice in their pharmacy. The attitude of general practitioners towards the care-providing function of the community pharmacist correlates significantly with the relationship between general practitioners and pharmacists (P < 0.001). There is also a significant difference (P < 0.001) in the attitude score between dispensing and non-dispensing general practitioners: dispensing general practitioners scored lower on the attitude scale.

CONCLUSION

Pharmacists and general practitioners largely agree on the pharmacotherapeutic signalling role that a pharmacist should fulfill. A good relationship benefits the attitude of general practitioners towards the pharmacist's care-providing function.

Ethical and legal implications of pharmacogenomics

Pharmacogenomics is the application of genomics technology to the discovery and development of drugs. A greater understanding of the way in which individuals with a particular genotype respond to a drug allows manufacturers to identify population subgroups that will benefit most from a particular drug. The increasing emphasis on pharmacogenomics is likely to raise ethical and legal questions regarding, among other things, the design of research studies, the construction of clinical trials and the pricing of drugs.