Opinion of Polish Patients with Epilepsy on Generic Medications

AIM

The majority of medicines used in Poland are generic drugs and substitutions of the originals. The objective of this study was to obtain information on the current knowledge about generic medicines among Polish patients with epilepsy.

MATERIAL AND METHODS

The conducted study was based on a self-developed questionnaire. The questionnaire consisted of 26 questions, including the questions regarding the respondents' knowledge about generics, their previous experience, and the factors behind these choices.

RESULTS

Overall, 1220 questionnaires were analyzed. Among all patients, 66.4% reportedly had heard about generics. Of these, 61.5% of patients had used generic drugs in the past. A significant proportion of participants had never been recommended to switch to a generic medicine by their healthcare professional (23% physicians and 13.9% pharmacists). Statistically, relevant differences were observed regarding the respondents' kind and level of education, place of residence, and net income per household.

CONCLUSIONS

Significant gaps were identified in the knowledge and perceptions among patients regarding generic medicines, especially in relation to their efficacy and safety. Efforts must be directed towards increasing public awareness of generic medicines and there should also be a focus on educating patients about generic medicines.

New pricing models for generic medicines to ensure long-term sustainable competition in Europe

Background: Price erosion of generic medicines over time as a result of existing pricing policies in combination with increasing operational costs of these products due to high inflation, undermine long-term sustainable competition in European off-patent medicines markets. Therefore, the aim of this study is to identify new potential pricing models for retail generic medicines in Europe, examine their pros and cons, and illustrate them with examples inside or outside the pharmaceutical sector. Methods: A targeted literature review, one-to-one interviews and a joint advisory board meeting with experts from five European countries were carried out to assess potential pricing models for generic medicines. Results: We identified ten pricing models that can be applied to generic medicines. The tiered pricing model is viewed as a sustainable solution ensuring competitiveness, but requires market monitoring using a supportive IT infrastructure. De-linking the price of generic medicines from that of the off-patent originator medicine prevents the originator from forcing generic medicines' prices to unsustainable levels. Higher costs due to inflation can be compensated in the automatic indexation model. Other pricing models that have less implementation potential include the one-in-one/multiple-out model, tax credits, value-based pricing, volume for savings and guaranteed margin/fee models. The hypothecated tax and cost allocation models, which add a patient fee to generic medicines prices, are not likely to be socially acceptable. Conclusion: When considering a new pricing model for generic medicines, the impact on innovative medicines and the characteristics of the healthcare system in a given country need to be taken into account. Also, there is a need to continuously follow up the level of competition in off-patent medicines markets and to identify sustainability risks.

Analysis of the evolution of the price of oncology drugs after the loss of their patent and the marketing of generic medicines

Background and research question:

Loss of exclusivity of oncology drugs causes an important drop in their price due to the marketing of generic medicines. In this article we study how the price of certain oncology drugs evolves throughout time after the loss of their patent, both in terms of the notified price and at a level of the public tenders for the purchase of medicines.

Methods:

The variation in the price of oral oncology drugs was assessed from the public information provided by the Interministerial Medicinal Products Pricing Committee (Comisión Interministerial de Precios de los Medicamentos, CIPM) and the data from public tenders for the purchase of medicines.

Results:

The data show a significant drop in price of the medicines assessed after the expiry of their patent, both at a notified price level (70% of average drop in price in 2.6 years) and at the level of the public tenders (drops exceeding 90% in a year for the most innovative drugs).

Discussion:

The drop in the price of the oncology drugs after the expiry of their patent is seen in all the medicines assessed. The trends seen allow to predict the evolution of the price of another innovative medicine that is nearing the expiry of its patent (Lenalidomide), with an expected drop in price by 90% with respect to the current price of the innovative drug.

Does TRIPS (Agreement on Trade-Related Aspects of Intellectual Property Rights) prevent COVID-19 vaccines as a global public good?

The article analyses the global public goods approach to COVID-19 technologies, embedded in 2020 affirmations by the World Health Assembly (WHA), the UN Human Rights Council and G20 on broad immunization against COVID-19. After identifying the access to COVID-19 tools (ACT) Accelerator members, the UN efforts are identified, focusing primarily on the UN human rights bodies, acknowledging how these and the WHA have mutually reinforced each others' efforts. The article finds that the global public goods terminology appeared in UN resolutions in 2020, while wording that included vaccines-on an equal footing as medicines-appeared in 2016, and recognition of generic medicines appeared in 2019. The so-called Trilateral Cooperation on IP and public health between two UN specialized agencies and the World Trade Organization (WTO) has increased awareness of the flexibilities within WTO's TRIPS Agreement. These flexibilities are explained. With notable exceptions, like India, these flexibilities are not widely applied in domestic legislation. A different emphasis characterizes the millennium development goals era as compared to the sustainable development goals era, and this shift is explained by applying relevant theories. Among pro-TRIPS developed countries there is an acknowledgment of obstacles created by the IP system, but their overall position has not changed.

Knowledge and Attitude of Physicians Towards the Cost of Commonly Prescribed Medicines: A Case Study in Three Nigerian Healthcare Facilities

OBJECTIVE

One of the core principles of rational prescribing is consideration of the cost of the medicines prescribed, especially in countries with high patient copayments and low incomes such as Nigeria. Little is known about Nigerian physicians' knowledge about the cost of commonly prescribed medicines. The principal objective of the study was to assess the knowledge of Nigerian physicians about the cost of commonly prescribed medicines.

METHODS

Descriptive cross-sectional survey conducted among physicians in 3 tertiary institutions in Nigeria. Apart from socio-demographic and other information, questions about the estimated costs of branded and generic versions of 11 commonly prescribed medications were included in the questionnaire.

RESULTS

One hundred and seventy-nine (179; 95.7%) respondents agreed that costs of medicines were important when writing prescriptions, although only 7 (3.7%) of them had any formal training in the economics of healthcare. The median percentages of respondents with accurate estimated costs for generic and originator brands were 6.2% and 12%, respectively. Respondents were more knowledgeable about the cost of medicines used for the treatment of infectious diseases (malaria, bacterial infections) than noncommunicable diseases (diabetes mellitus, hypertension, and dyslipidemia).

CONCLUSIONS

The knowledge of Nigerian physicians in the 3 participating hospitals about the costs of commonly prescribed medicines was poor. This is despite their awareness about the importance of costs of medicines when prescribing.

Knowledge, Perception and Attitude Regarding Generic Medicines among Iraqi Physicians

OBJECTIVES

The study aim was to explore the knowledge, perceptions, and attitudes of Iraqi physicians regarding generic and locally manufactured medicines.

METHODS

A total of 124 physicians were involved in this cross -sectional study. The convenience sample was collected from five public hospitals in Baghdad. A self-administered questionnaire was distributed and collected in-person. Fisher's Exact Test was used to measure the association between physician years of experience, gender and categorical (perception and knowledge) variables.

RESULTS

Most respondent answers regarding the knowledge of generic medicines were incorrect. Only up to one-third of the participants knew that generic medicines are therapeutically equivalent to brand name medicines (26.6%), as safe as brand name medicines (34.7%) and required to meet similar safety standards as brand name medicines (12.1%). With respect to perception, many physicians had negative perceptions about generic medicines such as viewing generic medicines as lower quality (57.3%) and cause more side effects (41.1%) compared to brand name medicines. Regarding physician attitudes toward generic medicines, about two-thirds (64.5%) of the physicians were willing to prescribe low cost medicines; however, only about half (51.6%) of the physicians reported they offer generic medicines to their patients. Finally, 64.5% of the participants were not comfortable with pharmacist replacing prescribed brand with generic medicines.

CONCLUSIONS

In general, Iraqi physicians have negative perceptions and attitudes about generic and locally manufactured medicines. Significant gaps were identified in the knowledge and perceptions among physicians regarding generic medicines especially in relation to efficacy and safety of generic medicines.

The effects of the financial crisis on the general and dental health status of Greek citizens

PURPOSE

To present the impact of the financial crisis on health status and dental health in Greece and compare it to the European Union and Finland and to identify any changes in health-related expenditure focusing on pharmaceutical expenditure and generic medicines.

DESIGN/METHODOLOGY/APPROACH

Databases as Scopus, Pubmed, Google Scholar, World Health Organization, Eurostat, and Elstat were used.

FINDINGS

Indicators, such as mortality and life expectancy, show that there is no clear correlation between health deterioration and financial crisis while dental health has deteriorated. Out-of-pocket expenses were found to be catastrophic, and the use of generic medicines is still limited.

PRACTICAL IMPLICATIONS

Proper prescribing of medicines, coverage of health care costs by the government, and cost savings from the use of generic medicines were implemented. As regards dental care, the state should focus on prevention as well as reinforcement of public dental care services.

ORIGINALITY/VALUE

The break through idea is to compare the impact of the financial crisis on health indexes in Greece with the European Union and Finland, to focus on pharmaceutical expenditure, generic medicines, and dental health.

Evaluating access to essential medicines for treating childhood cancers: a medicines availability, price and affordability study in New Delhi, India

Introduction

Limited access to essential medicines (EMs) for treating chronic diseases is a major challenge in low-income and middle-income countries. Although India is the largest manufacturer of generic medicines, there is a paucity of information on availability, price and affordability of anti-neoplastic EMs, which this study evaluates.

Methods

Using a modified WHO/Health Action International methodology, data were collected on availability and price of 33 strength-specific anti-neoplastic EMs and 4 non-cancer EMs. Seven 'survey anchor' hospitals (4 public and 3 private) and 32 private-sector retail pharmacies were surveyed. Median price ratios (MPRs) were calculated by comparing consumer prices with international reference prices (IRPs).

Results

On average, across survey anchor areas (hospital and private-sector retail pharmacies combined), the mean availability of anti-neoplastic EMs and non-cancer medicines was 70% and 100%, respectively. Mean availability of anti-neoplastic EMs was 38% in private-sector retail pharmacies, 43% in public hospital pharmacies and 71% in private hospital pharmacies. Median MPR of lowest-priced generic versions was 0.71 in retail pharmacies. The estimated cost of chemotherapy medicines needed for treating a 30 kg child with standard-risk leukaemia was INR 27 850 (US$442) and INR 17 500 (US$278) for Hodgkin's lymphoma, requiring 88 and 55 days' wages, respectively, for the lowest paid government worker.

Conclusion

Most anti-neoplastic EMs are found in survey anchor areas, however, mean availability was less than non-cancer medicines; not meeting the WHO target of 80%. Medicine prices were relatively low in New Delhi compared with IRPs. However, the cost of chemotherapy medicines seems unaffordable in the local context.

Multiple Sclerosis: A Global Concern with Multiple Challenges in an Era of Advanced Therapeutic Complex Molecules and Biological Medicines

Multiple sclerosis (MS) has become a common neurological disorder involving populations previously considered to be infrequently affected. Genetic dissemination from high- to low-risk groups is a determining influence interacting with environmental and epigenetic factors, mostly unidentified. Disease modifying therapies (DMT) are effective in treating relapsing MS in variable degrees; one agent is approved for primary progressive disease, and several are in development. In the era of high-efficacy medications, complex molecules, and monoclonal antibodies (MAB), including anti-VLA4 (natalizumab), anti-CD52 (alemtuzumab), and anti-CD20 (ocrelizumab), obtaining NEDA (no evidence of disease activity) becomes an elusive accomplishment in areas of the world where access to MS therapies and care are generally limited. Countries' income and access to public MS care appear to be a shared socioeconomic challenge. This disparity is also notable in the utilization of diagnostic tools to adhere to the proposed elements of the McDonald Criteria. The impact of follow-on medications ("generics"); injectable non-biological complex drugs (NBCD), oral sphingosine-1-phosphate receptor modulators, and biosimilars (interferon 1-a and 1-b), utilized in many areas of the world, is disconcerting considering these products generally lack data documenting their efficacy and safety. Potential strategies addressing these concerns are discussed from an international point of view.

Exploring the Knowledge and Perception of Generic Medicines among Final Year Undergraduate Medical, Pharmacy, and Nursing Students in Sierra Leone: A Comparative Cross-Sectional Approach

Most low-income nations have national medicine policy that emphasized the use of generic medicines in the public health sector. However, the use of generics is often debatable as there are concerns over its efficacy, quality, and safety compared to their branded counterparts. This study was conducted to compare the knowledge and perception of generic medicines among final year undergraduate medical, pharmacy, and nursing students in Sierra Leone. We conducted a questionnaire-based cross-sectional study among these students at the College of Medicine and Allied Health Sciences University of Sierra Leone. Out of the 62 students, only two (2/62, 3.2%) knew about the acceptable bioequivalence limit. At least half of respondents in all three groups agreed that all generics are therapeutically equivalent to their innovator brand. At least half of the medicine (21/42, 50%) and nursing (6/9, 66.6%) students, compared to pharmacy students (5/11, 45.5%), believed that higher safety standards are required for proprietary medicines than for generic medicines. Most of them agreed that they need more information on the safety, quality, and efficacy aspects of generics (59/62, 95.2%). All three groups of healthcare students, despite variations in their responses, demonstrated a deficiency in knowledge and misconception regarding generic medicines. Training on issues surrounding generic drugs in healthcare training institutions is highly needed among future healthcare providers in Sierra Leone.

Global Harmonization of Comparator Products for Bioequivalence Studies

Comparator products should be the products that were shown to be safe and efficacious in pivotal clinical trials to ensure prescribability of generics. The use of a common comparator ensures switchability between generics. The selection of the comparator is a national responsibility and may be different between countries. This paper discusses the current recommendations on selection of comparators, the associated problems, and the possibility of harmonization. Most countries follow the World Health Organization (WHO) recommendations for selecting comparator products and require the comparator product to be obtained from their national markets to ensure switchability between the local comparator and their generics. These recommendations are only feasible in the few countries where the repetition of the bioequivalence study is economically feasible, but they are impracticable in all other countries. Furthermore, the exclusive use of the local comparator to ensure switchability is ethically and scientifically questionable. The innovator product from well-regulated markets should be the global comparator. This harmonization is feasible as the concept already applies in the WHO prequalification program. It is ineffectual to harmonize only the requirements for performing bioequivalence studies, if such a study has to be repeated for every single country simply because of the different comparator products.

Assessment of knowledge and perceptions toward generic medicines among basic science undergraduate medical students at Aruba

Objective:

Use of generic medicines is important to reduce rising health-care costs. Proper knowledge and perception of medical students and doctors toward generic medicines are important. Xavier University School of Medicine in Aruba admits students from the United States, Canada, and other countries to the undergraduate medical (MD) program. The present study was conducted to study the knowledge and perception about generic medicines among basic science MD students.

Materials and Methods:

The cross-sectional study was conducted among first to fifth semester students during February 2015. A previously developed instrument was used. Basic demographic information was collected. Respondent’s agreement with a set of statements was noted using a Likert-type scale. The calculated total score was compared among subgroups of respondents. One sample Kolmogorov–Smirnov test was used to study the normality of distribution, Independent samples t-test to compare the total score for dichotomous variables, and analysis of variance for others were used for statistical analysis.

Results:

Fifty-six of the 85 students (65.8%) participated. Around 55% of respondents were between 20 and 25 years of age and of American nationality. Only three respondents (5.3%) provided the correct value of the regulatory bioequivalence limits. The mean total score was 43.41 (maximum 60). There was no significant difference in scores among subgroups.

Conclusions:

There was a significant knowledge gap with regard to the regulatory bioequivalence limits for generic medicines. Respondents’ level of knowledge about other aspects of generic medicines was good but could be improved. Studies among clinical students in the institution and in other Caribbean medical schools are required. Deficiencies were noted and we have strengthened learning about generic medicines during the basic science years.

Generic medicines and generic substitution: contrasting perspectives of stakeholders in Ireland

BACKGROUND

The Health (Pricing and Supply of Medical Goods) Act 2013 passed into law in July 2013 and legislated for generic substitution in Ireland. The aim of the study was to ascertain the knowledge and perceptions of stakeholders i.e. patients, pharmacists and prescribers, of generic medicines and to generic substitution with the passing of legislation.

METHODS

Three stakeholder specific questionnaires were developed to assess knowledge of and perceptions to generic medicines and generic substitution. Purposive samples of patients, prescribers and pharmacists were analysed. Descriptive quantitative and qualitative analyses were undertaken.

RESULTS AND DISCUSSION

A total of 762 healthcare professionals and 353 patients were recruited. The study highlighted that over 84% of patients were familiar with generic medicines and are supportive of the concept of generic substitution. Approximately 74% of prescribers and 84% of pharmacists were supportive of generic substitution in most cases. The main areas of concern highlighted by the healthcare professionals that might impact on the successful implementation of the policy, were the issue of bioequivalence with generic medicines, the computer software systems used at present in general practitioner (GP) surgeries and the availability of branded generics. The findings from this study identify a high baseline rate of acceptance to generic medicines and generic substitution among patients, prescribers and pharmacists in the Irish setting. The concerns of the main stakeholders provide a valuable insight into the potential difficulties that may arise in its implementation, and the need for on-going reassurance and proactive dissemination of the impact of the generic substitution policy.

CONCLUSION

The existing positive attitude to generic medicines and generic substitution among key stakeholders in Ireland to generic substitution, combined with appropriate support and collaboration should result in the desired increase in rates of prescribing, dispensing and use of generic medicines.

Generic medicines: issues and relevance for global health

Generic medicine is a pharmaceutical product which is bioequivalent to the innovator product in terms of dosage form, strength, route of administration, quality, safety, performance characteristics, and intended use. Generic medicines are a cornerstone for providing affordable medicines to patients. The major generic markets in the world include United States of America followed by European Union, Canada, Japan, and Australia. The major suppliers of generic medicines China and India are showing tremendous growth in the generic medicine sector. There are many legal and regulatory issues along with quality concerns associated with the use of the generic products. Lately, bilateral international agreements called free trade agreements, delaying tactics by originator companies like strategic patenting and litigations on generic manufacturers, have been a major setback for the generic medicine industry. These issues need to be addressed to optimize the use of generic medicines. The sustainability of generic medicine sector is crucial for improving access to essential medicines for the worldwide.

The impact of South Korea's new drug-pricing policy on market competition among off-patent drugs

INTRODUCTION

A new pricing policy was introduced in Korea in April 2012 with the aim of strengthening competition among off-patent drugs by eliminating price gaps between originators and generics.

OBJECTIVE

Examine the effect of newly implemented pricing policy.

METHODS

Retrospectively examining the effects through extracting from the National Health Insurance claims data a 30-month panel dataset (January 2011-June 2013) containing consumption data in four major therapeutic classes (antihypertensives, lipid-lowering drugs, antiulcerants and antidepressants). Proxies for market competition were examined before and after the policy.

RESULTS

The new pricing policy did not enhance competition among off-patent drugs. In fact, price dispersion significantly decreased as opposed to the expected change. Originator-to-generic utilization increased 6.12 times (p = 0.000) after the new policy.

CONCLUSIONS

The new pricing policy made no impact on competition among off-patent drugs. Competition in the off-patent market cannot be enhanced unless both supply and demand side measures are coordinated.

Generic drugs: Review and experiences from South India

The cost of pharmaceuticals, as a percentage of total healthcare spending, has been rising worldwide. This has resulted in strained national budgets and a high proportion of people without access to essential medications. Though India has become a global hub of generic drug manufacturing, the expected benefits of cheaper drugs are not translating into savings for ordinary people. This is in part due to the rise of branded generics, which are marketed at a price point close to the innovator brands. Unbranded generic medicines are not finding their way into prescriptions due to issues of confidence and perception, though they are proven to be much cheaper and comparable in efficacy to branded medicines. The drug inventory of unbranded generic manufacturers fares reasonably when reviewed using the World Health Organization-Health Action International (WHO-HAI) tool for analysing drug availability. Also, unbranded generic medicines are much cheaper when compared to the most selling brands and they can bring down the treatment costs in primary care and family practice. We share our experience in running a community pharmacy for an urban health center in the Pathanamthitta district of Kerala State, which is run solely on generic medicines. The drug availability at the community pharmacy was 73.3% when analyzed using WHO-HAI tool and the savings for the final consumers were up to 93.1%, when compared with most-selling brand of the same formulation.

Does increased use of generic medicines by elders in Belgium help to contain escalating health care budgets?

This study explored the use of generic medicines among elders in Belgium. The generic market share by volume for elders in 2010 was 23.1%, while this was 23.7% for the total Belgian population in 2009. Pharmaceutical expenditure in Belgium was €649.74 per capita for elders in 2010. Calculations of possible savings through an increased use of generic medicines showed that these savings were rather limited (4.48% when the generic market share by volume increased to 95%). The full potential of generic medicines in the elder population has not yet been realized in Belgium, due to the limited use of generic medicines and their relatively high prices. The Belgian government should implement additional incentives for physicians, pharmacists, and patients to increase the use of generics and combine these with policies to lower prices of generic medicines and policies to decrease the volume of medicines used by elders and rationalize the prescribing of medicines for elders.

Societal value of generic medicines beyond cost-saving through reduced prices

OBJECTIVE

This paper aims to provide an overview of the added societal value of generic medicines beyond their cost-saving potential through reduced prices. In addition, an observational case study will document the impact of generic entry on access to pharmacotherapy in The Netherlands and an illustrative exercise was carried out to highlight the budget impact of generic entry.

METHODS

A narrative literature review was carried out to explore the impact of generic medicines on access to pharmacotherapy, innovation and medication adherence. Data from the Medicines and Medical Devices Information Project database in The Netherlands were used for the case study in which the impact of generic medicine entrance on the budget and the number of users was calculated as an illustrative exercise.

RESULTS

Generic medicines have an additional societal value beyond their cost-saving potential through reduced prices. Generic medicines increase access to pharmacotherapy, provide a stimulus for innovation by both originator companies and generic companies and, under the right circumstances, have a positive impact on medication adherence.

CONCLUSION

Generic medicines offer more to society than just their cost-saving potential through reduced prices. As such, governments must not focus only on the prices of generic medicines as this will threaten their long-term sustainability. Governments must therefore act appropriately and implement a coherent set of policies to increase the use of generic medicines.

Analysis of French generic medicines retail market: why the use of generic medicines is limited

The market share of generic medicines in France is low compared to other European countries. This perspective paper provides an overview of the generic medicines retail market in France and how the current policy environment may affect the long-term sustainability. Looking at the French generic medicines retail market and the surrounding regulatory framework, all conditions seem to be in place to create a healthy generic medicines market: the country has well-respected regulatory authorities, generic medicines enter the market in a timely manner and prices of generic medicines are competitive compared with other European countries. Despite the success of the demand-side policies targeted at pharmacists and patients, those targeted at physicians were less successful due to a lack of enforcement and a lack of trust in generic medicines by French physicians. Recommendations to increase the use of generic medicines in France round off this perspective paper.

Analysis of Spanish generic medicines retail market: recommendations to enhance long-term sustainability

The use of generic medicines in Spain is traditionally low compared to other European countries, despite efforts of the Spanish government in the past. This paper provides a perspective on the Spanish generic medicines retail market and how the current policy environment may affect the long-term sustainability. The Spanish government's focus on prices of generic medicines (e.g., mandatory price cuts, reference price set at the lowest level) have made them amongst the lowest in Europe. In our opinion, this combination of continuous pressure on prices and limited diffusion of generic medicines may undermine the long-term sustainability of the Spanish generic medicines retail market. The unique experience in Spain shows the impact of demand-side policies on the use of generic medicines. Because a sustainable generic medicines retail market is important to maintain future competition in the off-patent medicines market, this perspective paper rounds off with recommendations to increase its sustainability.

Generic medicine substitution: a cross-sectional survey of the perception of pharmacists in North-Central, Nigeria

OBJECTIVE

To investigate the views of pharmacists in North-Central Nigeria on generic medicines and generic substitution practices.

SUBJECTS AND METHOD

A cross-sectional survey was conducted in 4 cities in North-Central Nigeria from April to June 2012 among 330 pharmacists in hospital and community pharmacy settings, recruited through a convenience sampling strategy. Data were collected using a prevalidated self-administered questionnaire and entered into SPSS version 16.0 software to generate descriptive statistics. Binary logistic regression was conducted to determine the demographic predictors of preference for generic substitution among respondents.

RESULTS

The response rate was 46.7% (n = 154). Eighty-four (54.5%) respondents reported that generic medicines were not of equivalent quality to branded ones. There was no significant difference (p > 0.05) in the perception of respondents regarding the quality of imported generic medicines over locally manufactured ones. While 143 (92.9%) respondents supported generic substitution practices, 105 (68.2%) would prefer to recommend generic medicines over branded ones. Hospital pharmacists were more likely (OR = 2.6; 95% CI 1.2-5.8) than community pharmacists to recommend generic medicines. One hundred and fifty-three (99.4%) respondents would support the implementation of a future generic substitution right for pharmacists in Nigeria.

CONCLUSION

The present study showed a high support for generic substitution and future generic substitution rights for pharmacists in Nigeria.

Where are we now: assessing the price, availability and affordability of essential medicines in Delhi as India plans free medicine for all

BACKGROUND

Inequitable access to medicines is a major weakness in the Indian health care system. Baseline data needed to develop effective public health policy and provide equitable access to essential medicines. The present survey was conducted to investigate the price, availability, and affordability of fifty essential medicines in the public and private sector in Delhi, India using standardized WHO/HAI methodology.

METHODS

Data on procurement price and availability was collected (July-October 2011) from three public healthcare providers: the federal (central) government, state government and Municipal Corporation of Delhi (MCD). Data on price and availability of medicines was collected from private retail and chain pharmacies of a leading corporate house. Prices were compared to an international reference price (expressed as median price ratio-MPR).

RESULTS

The procurement price of surveyed medicines was 0.53-0.82 times the international reference price-IRP. However, the overall mean availability of surveyed medicines in facilities under state government and MCD was 41.3% and 23.2%, respectively. The overall mean availability of medicines in three tertiary care facilities operated by the federal government was 49.3%. Availability of generic medicines was much higher in the private sector. Off-patented medicines, like diazepam, diclofenac, and doxycycline had the highest MPRs. The price ratio between procurement and retail was as high as 28 (range 11-28) for certain medicines. Seven-day treatment with a popular brand of amoxicillin+clavulanic acid or one inhaler each of budesonide and salbutamol cost 2.3 and 1.4 days' wages for the lowest paid government worker. A majority of India's population cannot afford these prices.

CONCLUSIONS

This study revealed that procurement prices of surveyed medicines were reasonable in comparison to IRP. However, variation in procurement prices of certain medicines by different public procurement agencies was noted. Availability of medicines was very poor in public sector facilities, which are the primary source of free medicines for a majority of India's low-income population. Availability of medicines is better in private retail pharmacies but affordability remains a big challenge for a majority of the population. These data have significant policy implications that could help in amending policies to increase the access to essential medicines for India's population.

Exploring knowledge and perceptions of generic medicines among drug retailers and community pharmacists

The study was carried out to evaluate community pharmacists’ and drug retailers’ knowledge and perceptions about generic medicines. A cross-sectional descriptive study, with a questionnaire, was conducted to survey community pharmacists and drug retailers working in 39 randomly selected private pharmacies from two towns of Tamil Nadu, India. Among 66 respondents (pharmacists and drug retailers), 39 (59.1%) were drug retailers; 52 (78.8%) were self-employed; majority in the age group 31-40 (31.8%); and mostly males (83.3%). Overall, 21 respondents (31.8%) did not know what generic medicines were. About 30% of the respondents thought that generic medicines are of inferior quality compared to branded medicines. Only 63.6% of the surveyed pharmacists and drug retailers agreed that generic medicines can be considered therapeutically equivalent with the branded ones. A higher level of education had a direct relationship having correct knowledge of generic medicines (P<0.01). The majority of the respondents (80%) did not support generic substitution, even in case of prescribed medicines are not available. Many community pharmacists and drug retailers have misconceptions regarding generic medicines. Lack of knowledge may negatively affect the community pharmacists’ support towards generic medicines in India. This issue should be addressed by academicians and other relevant bodies.

Perception and attitude of general practitioners regarding generic medicines in Karachi, Pakistan: A questionnaire based study

OBJECTIVES

In developing countries out-of-pocket payments (OOP) are as high as 80% of healthcare spending. Generic medicines can be instrumental in reducing this expenditure. The current study is aimed to explore the knowledge, perception, and attitude of general practitioners towards generic medicines in Karachi, Pakistan.

METHODS

This exploratory, descriptive study was conducted on a sample of 289 randomly selected general practitioners who were dispensing at their private clinics in Karachi, Pakistan. The questionnaires were distributed and collected by hand. Data was entered to SPSS version 17. Fischer's exact test was applied to see the association between variables.

RESULTS

A total of 206 questionnaires were included in the study. A response rate of 71.3% was achieved. Out of 206 respondents, 139 (67.5%) were male while 67 (32.5%) respondents were female. Close to three quaters of the respondents (n= 148; 71.8%) showed correct knowledge about generic medicines being a 'copy of the brand name medicines' and 'interchangeable with brand name medicines' (n= 148; 71.8%). In terms of safety, the majority of respondents (n=85; 41.26%) incorrectly understood that the generic medicines are less safe than brand name medicines. The total percentage of correct responses was seen in 53% of the respondents. More than half of the respondents agreed that locally manufactured medicines are of the same effectiveness as brand name medicines (n=114; 55.4%). Male practitioners with practice experience of 11-15 years showed positive perception towards the quality of multinational products. The Majority of respondents believed that their prescribing decision is influenced by medical representatives (n=117; 56.8%). More than three-quarters of the respondents expressed their wish to prescribe low cost medicines in their practice (n=157; 76.2%). More than one third of the respondents expressed their uneasiness to prescribe products from all local manufacturers (n=72; 35%).

CONCLUSION

There were gaps identified in the knowledge of respondents. Although good perception and attitude were noted among the respondents, dissemination of information regarding generic medicines may perhaps strengthen generic prescribing. There is a need to introduce 'Quality by Design' concept in local manufacturing units. This, in turn, can inculcate confidence in prescribers towards locally manufactured generic medicines.

Generic Medicine Pricing Policies in Europe: Current Status and Impact

Generic medicine pricing is an area of national responsibility of European Union countries. This article aims to present the current status and impact of generic medicine pricing policies in ambulatory care in Europe. The study conducts a literature review of policies relating to free-pricing systems, price-regulated systems, price differentiation, price competition and discounts, and tendering procedures; and a survey of European generic medicine pricing policies. Competition from Indian generic medicine manufacturers, European variation in generic medicine prices and competition between generic medicine manufacturers by discount suggest that the potential savings to health care payers and patients from generic medicines are not fully realized in Europe. One way of attaining these savings may be to move away from competition by discount to competition by price. Free-pricing systems may drive medicine prices downwards under specific conditions. In price-regulated systems, regulation may lower prices of originator and generic medicines, but may also remove incentives for additional price reductions beyond those imposed by regulation. To date, little is known about the current status and impact of tendering procedures for medicines in ambulatory care. In conclusion, the European experience suggests that there is not a single approach towards developing generic medicine pricing policies in Europe.

[Views of primary care users concerning generic medicines and the cost of medication]

OBJECTIVES

To assess primary care users' views on generic drugs, approach to them and degree of understanding of them; and to find the importance they attach to the economic cost of medication.

DESIGN

Transversal, descriptive study.

SETTING

Primary care.

PARTICIPANTS

A sample of 231 patients was selected from all the people over 18 who attended the health centre for medical consultation during 2001.

RESULTS

60% (95% CI, 55.22%-67.42%) of those surveyed said they had heard of generic medicines. The communications media were the main source of information, accounting for 78.4% of cases (95% CI, 69.19%-83.96%). 48.04% (95% CI, 38.04%-58.16%) of those who had heard of generic medicines had taken them on some occasion; and 32.4% (95% CI, 23.42%-42.34%) normally took them. 76.47% (95% CI, 67.04%-84.30%) did not mind or, where appropriate, would not mind if their doctor changed a medicine they normally took for a generic one. The mean age of those who did not mind was significantly lower than that of those who did. 50% (95% CI, 42.25%-52.75%) of those questioned were very interested in the cost of drugs prescribed by their doctors: people still working were more interested than those on a pension. 67.6% (95% CI, 60.06%-74.61%) believed that doctors should try to prescribe the cheapest drugs, as long as they were equally efficacious. 78.8% of those questioned (95% CI, 71.91%-84.70%) would choose the cheaper of two drugs which were the same bar the cost.

CONCLUSIONS

Most patients in our study were aware of generic drugs and were not against the replacement of a medicine they were already taking by a generic one. They did not relate drugs' cost to their quality.

[The substitution of generic for brand medicines in family medical clinics]

OBJECTIVE

To estimate the percentage of patients who change from current medication to generic medicine once properly informed.

DESIGN

Observational, cross-sectional.Setting. Two primary care clinics in Madrid, one rural and the other urban.Participants. Patients who came for their consultation and who take prescribed drugs which have generic alternatives.

METHOD

All patients included received a standard 40 second verbal explanation about generics. Later, the researcher filled out a 18 items test. A descriptive analysis was done taking into account frequencies and applying a bivariable analysis comparing the variable <<accepted change>> with the others.

RESULTS

71% of the patients accepted the change to generic medicine, 29% did not. Of the latter, 67.4% said that they preferred to consult with the prescribing physician; 45.1% were of the opinion that it would not have the same effect; a 16.1% said that if it was cheaper, it must be of a worse quality; and another 16.1% said that they would only accept the change if it meant saving some money.The researcher perceived distress and discomfort in 23.4% of the patients. He himself felt satisfied in 83.9% of the cases, indifferent in 12.9% and unsatisfied in 3.2%.

CONCLUSION

Providing the adequate information and letting the patients decide for themselves about the substitution of brand for generic drugs resulted in almost three quarters of the cases opting for the change. And this with a minimal professional effort and the added benefit of improving the patient-practioner relationship.