Potential Clinical and Economic Impact of Switching Branded Medications to Generics

Abstract

Switching branded to generic medications has become a common cost-containment measure. Although this is an important objective for health care systems worldwide, the impact of this practice on patient outcomes needs to be carefully considered. We reviewed the literature summarizing the potential clinical and economic consequences of switching from branded to generic medications on patient outcomes. A literature search of peer-reviewed articles published 2003–2013 using key words of “generic switching” or “substitution” was conducted using PubMed, OvidSP, and ScienceDirect. Of 30 articles identified and reviewed, most were related to the diseases of the central nervous system, especially epilepsy. Based on our review, potential impacts of switching fell into 3 broad categories: patient attitudes and adherence, clinical and safety outcomes, and cost and resource utilization. Although in many cases generics may represent an appropriate alternative to branded products, this may not always be the case. Specifically, several studies suggested that switching may negatively impact medication adherence, whereas other studies found that generic switching was associated with poorer clinical outcomes and more adverse events. In some instances, switching accomplished cost savings but did so at increased total cost of care because of increased physician visits or hospitalizations. Although in many cases generics may represent an appropriate alternative, mandatory generic switching may lead to unintended consequences, especially in certain therapeutic areas. Although further study is warranted, based on our review, it may be medically justifiable for physicians and patients to retain the right to request the branded product in certain cases.

<p>Community Pharmacy Personnel Understanding of Antibiotic Dispensing in Eastern Nepal</p>

“…Although brand switching (proprietary to generic) may represent an appropriate alternative in many cases, there may be an associated risk that must be considered. 37 The Pharmaceutical Society of Australia has brand substitution guidelines for pharmacists. 38 These guidelines state that the health and safety of the patient should be the foremost concern if substitution has to occur, and that whenever possible, the same product should be supplied to patients on chronic therapy.…”

Improving Global Healthcare and Reducing Costs Using Second-Generation Artificial Intelligence-Based Digital Pills: A Market Disruptor

“…The cost of prescription drugs, including life-saving drugs, is rising far faster than inflation [ 29 ]. Switching from branded to generic medications is a common cost-containment measure for healthcare systems [ 30 ]. Increased incentives for generic drug use are proposed as a means for improving overall health [ 31 , 32 ].…”

Cluster randomised trials of prescribing policy: an ethical approach to generating drug safety evidence? A discussion of the ethical application of a new research method

“…Individual prescribers in the NHS remain free to prescribe as they see fit, and there are limitations only for very costly or high-risk treatments. Prescribing policy changes can result in changes being made to a patient's existing routine medications and require no ethical approval or individual patient consent, although a general notification of the change is sometimes provided [17]. These bulk medication changes, referred to as "switches" within the NHS, can be met with suspicion or confusion, and patients sometimes object to changes towards cheaper generic drugs [17].…”