Generic prescribing, brand and generic substitution, availability and cost effectiveness of the available medicines

Abstract

Background: Pharmaceuticals play a key role in the prevention and treatment of disease. The worldwide availability of effective, safe and affordable pharmaceuticals is a key challenge for the global public health system. Large economic interests are at stake within the field of pharmaceuticals. Pharmaceutical sales are existed as trade in many part of developing world including Nepal. At the same time, consumers (patients) are at mercy and unable to judge the quality, safety and, in many cases, the efficacy of the medicine, as well as whether the price is reasonable or not. They depend on others for assured quality medicines. Objective of this study was to find out the prescription written in generic name, availability of generic medicine in hospital pharmacy and outside pharmacy and cost effectiveness of brand –generic substitution in Manmohan Memorial Hospital Premises, Shyombu Kathmandu.Methods: All relevant information of brand-generic medicines and generic prescribing were recorded from the patient chart stored at medical record department except orthopedic department. In Orthopedic department, OPD prescriptions were recorded. Hospital pharmacy and outside pharmacy have been audited for the availability of generic medicines. Face to face interview with pharmacists in hospital and Drug Retailers were taken regarding the medicine available in generic name and medicine substitution. The recorded data were analyzed.Results: Only 298 out of 5120 medicines were found in generic name mostly from medical department, 215 medicines out of 812 medicines. There was no any single generic prescription in orthopedic department. In the hospital pharmacy and outside pharmacy have very few generic medicines. So no question of brand substitution by generic here. Mostly some large volume parental were available in generic names.Conclusion: Only 5.82 % of medicines were prescribed in generic name. Concerns over the therapeutic equivalence of branded products and generics are common amongst physicians, pharmacists and industries of course.JMMIHS.2018;4(1):33-42

Generic Medicine and Generic Prescribing in Nepal: An Implication for Policymakers

“…Generally, they are available under the brand name or proprietary name (local manufacturer gives brand names for marketing purposes) than under the generic in the Nepalese market. 30 , 31 Pharmaceutical companies use various approaches such as attractive brand names, packaging outlook, dosage formulation variation, and apply various marketing schemes, including push sales with bonuses to attract physicians, pharmacists, and patients towards their products through branded prescribing, dispensing and consumption. Studies showed that 90–95% of medicines are prescribed in brand name in tertiary care health facilities where patients have the choice to choose generic alternative; whereas, only around 40% of medicines were found to be prescribed in brand name in governmental healthcare facilities where the government freely supplies the medication, and generally, patients do not have to purchase out of pocket.…”

“…Studies showed that 90–95% of medicines are prescribed in brand name in tertiary care health facilities where patients have the choice to choose generic alternative; whereas, only around 40% of medicines were found to be prescribed in brand name in governmental healthcare facilities where the government freely supplies the medication, and generally, patients do not have to purchase out of pocket. 7 , 8 , 30 , 32 …”

“…A systematic review of 2015 showed that healthcare professionals, including doctors, have significant negative perception on generic medicines, 53 but this area is underreported in Nepal, and many prescribers prefer to prescribe in brand names and very rarely in generic in Nepal. 30 , 32 , 54 The reason to prescribe brand names is due to the enticement from the pharmaceutical firms to do so. However, this practice is crucial as there is a common trend among the public to undoubtedly follow the doctors’ recommendations on medication-related issues in Nepal.…”

Generic Prescribing: The Egyptian semblance

“…For instance, the pricing of generic medicine is set to be relative to the branded medicine. Generic drugs can be sold up to 60% less than the brand-name drugs in many European countries as in France [50%], Ireland and Greece [20%] [33,34]. Reference pricing which is classified in internal reference pricing and external reference pricing.…”