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Oosterhof P, Van Luin M, Brinkman K, Burger DM. Negative impact of a health insurer-mandated de-simplification from a single-tablet regimen to a two-tablet regimen. AIDS 2024; 38:1257-1262. [PMID: 38597511 PMCID: PMC11139245 DOI: 10.1097/qad.0000000000003905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/13/2024] [Accepted: 03/21/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Antiretroviral therapy (ART) accounts for a considerable proportion of HIV care expenses. In June 2021, a Dutch healthcare insurer implemented a mandatory policy to de-simplify branded RPV/TDF/FTC (Eviplera) into a two-tablet regimen containing rilpivirine (Edurant) and generic TDF/FTC as part of cost-saving measures. The objectives of this study were to evaluate the acceptance of this policy, the trends in ART dispensation, and cost developments. DESIGN A retrospective database study. METHODS In this study, medication dispensation data were obtained from the Dutch Foundation for Pharmaceutical Statistics (SFK). This database covers 98% of all medication dispensations from Dutch pharmacies including people with HIV who receive ART. We received pseudonymized data exclusively from individuals insured by the insurer for the years 2020-2022. Costs were calculated using Dutch drug prices for each year. RESULTS In June 2021, 128 people with HIV were on branded RPV/TDF/FTC. Following the policy implementation, 59 (46%) had switched to RPV + generic TDF/FTC, but after 1.5 years, only 17 of 128 individuals (13%) used the proposed two-tablet regimen. The other 111/128 used RPV/TDF/FTC with prescriptions for 'medical necessity' ( n = 29), switched to RPV/TAF/FTC ( n = 51), or other ART ( n = 31). Despite expectations of cost-savings, costs increased from €72 988 in May 2021 to €75 649 in May 2022. CONCLUSION A mandatory switch from an STR to a TTR in people with HIV proved unsuccessful, marked by low acceptance, and increased costs after 1 year. This underscores the necessity of incorporating patient and prescriber involvement in changing medication policies.
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Affiliation(s)
- Piter Oosterhof
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam
- Department of Pharmacy, Radboudumc Research Institute for Medical Innovation (RIMI), Radboud University Medical Center, Nijmegen
| | | | - Kees Brinkman
- Department of Internal Medicine, Division of Infectious Diseases, OLVG, Amsterdam, The Netherlands
| | - David M. Burger
- Department of Pharmacy, Radboudumc Research Institute for Medical Innovation (RIMI), Radboud University Medical Center, Nijmegen
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Wang Z, Wang R, Li X, Bai L, Fan P, Tang Y, Li X, Huang Y, Nie X, Han S, Shi L, Chen J. Influencing Factors of Generic Prescribing Behavior of Physicians: A Structural Equation Model Based on the Theory of Planned Behavior. Risk Manag Healthc Policy 2024; 17:1375-1385. [PMID: 38813068 PMCID: PMC11135567 DOI: 10.2147/rmhp.s446743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/13/2024] [Indexed: 05/31/2024] Open
Abstract
Background Although affordable generics could probably contribute to the solution of rapidly increasing pharmaceutical expenditure, those drugs are prescribed at a lower rate in China. Physicians' perception and knowledge of generics have a great influence on their prescribing behavior. Objective This study aimed to identify factors that affect physicians' generic prescribing behavior based on the theory of planned behaviors (TPB). Methods Data were collected by both electronic and paper-based surveys from 1297 Chinese physicians, and 1047 surveys were retained. The structural equation model (SEM) was employed to investigate the relationship between four behavioral constructs, namely, attitudes, subjective norms, perceived control of behaviors, and intentions. Results About 50% of Chinese physicians had a positive attitude towards generic drugs that had passed the "Consistency Evaluation of Quality and Efficacy of Generic Drugs" (high-quality generic drugs), but their knowledge of generic drugs was relatively inadequate. The path coefficients for the effect of attitudes, subjective norms, and perceived behavioral control on behavioral intention were 0.285, 0.366, and 0.322 respectively. The path coefficients for the effect of behavioral intention and perceived behavioral control on prescribing behavior were 0.009 and 0.410 respectively. Conclusion Physicians' attitudes, subjective norms, and perceived behavioral control were significant positive correlation predictors of behavioral intention. Subjective norms and perceived behavior control had a greater impact than attitude on physicians' prescribing intention. However, the generic prescribing behavior is not under the volitional control of Chinese physicians. Physicians' prescribing practice is likely affected by perceived strong control over prescribing generic drugs.
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Affiliation(s)
- Zhiyuan Wang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
| | - Ruilin Wang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
| | - Xiaoyu Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
| | - Lin Bai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
| | - Pingan Fan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
| | - Yuanyuan Tang
- Bidding Management Office, Suqian First Hospital, Suqian, Jiangsu, People’s Republic of China
| | - Xin Li
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Yangmu Huang
- School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Xiaoyan Nie
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
- International Research Center for Medicinal Administration, Peking University, Beijing, People’s Republic of China
| | - Sheng Han
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
- International Research Center for Medicinal Administration, Peking University, Beijing, People’s Republic of China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
- International Research Center for Medicinal Administration, Peking University, Beijing, People’s Republic of China
| | - Jing Chen
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, People’s Republic of China
- International Research Center for Medicinal Administration, Peking University, Beijing, People’s Republic of China
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Vergara I, Herrera-Noreña JS, López-Pacheco C, Soldevila G, Ortega E. Flow cytometry: A powerful analytical technique for characterizing the biological function of biotherapeutics and biosimilars. J Pharm Biomed Anal 2023; 235:115680. [PMID: 37634360 DOI: 10.1016/j.jpba.2023.115680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/02/2023] [Accepted: 08/22/2023] [Indexed: 08/29/2023]
Abstract
Biotherapeutics are complex molecules with therapeutic activity produced through biotechnology and/or genetic engineering. These medicines have clinical applications in diagnostic procedures and therapies for many disorders, including cancer, autoimmunity, and chronic degenerative diseases. Most biotherapeutics are expensive and sometimes unaffordable for low-income patients suffering from cancer or chronic illness. Biosimilars emerged in the 2000 s after patents of many innovative biotherapeutic products expired. The Biosimilar market is growing fast and demands reliable technologies for analyzing the physicochemical properties and bioactivity of products. A big challenge for biosimilar development is to prove comparable bioactivity, safety, efficacy, and toxicity profile as the innovator product. Bioactivity assessment can utilize different analytical techniques such as ELISA, flow cytometry, and surface plasmon resonance. Flow cytometry is a versatile analytical tool that can be used for the development of quantitative, reproducible, and accurate protocols suitable for routine evaluation of bioactivity in-vitro. Nevertheless, flow cytometry has been very scarcely used in comparability evaluation between biosimilar versus an originator product. Here, we review potential applications of flow cytometry to carry out functional bioassays of biotherapeutics or biosimilars.
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Affiliation(s)
- Irene Vergara
- Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico.
| | - Juan Sebastian Herrera-Noreña
- Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Cynthia López-Pacheco
- Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Gloria Soldevila
- Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Enrique Ortega
- Department of Immunology, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Bergmann F, Nussbaumer-Pröll A, Wulkersdorfer B, Eberl S, Ruppitsch W, Lepuschitz S, Zeitlinger M. Antimicrobial activity and pathogen mutation prevention of originator and generics of cefepime, linezolid and piperacillin/tazobactam against clinical isolates of Staphylococcus aureus. J Glob Antimicrob Resist 2023; 34:179-185. [PMID: 37473915 DOI: 10.1016/j.jgar.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/02/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES Although generic medicinal products are required to have the same qualitative and quantitative composition of the active substance as their reference originator product, patients and health care professionals express concerns about their interchangeability and safety. Therefore, the present study investigated the antimicrobial activity and pathogen mutation prevention of original and generic cefepime, linezolid and piperacillin/tazobactam against Staphylococcus aureus. METHODS Two generic formulations of cefepime, linezolid and piperacillin/tazobactam were tested against their respective originator products. Susceptibility testing was performed with twenty-one clinical isolates of S. aureus and ATCC-29213 using broth microdilution. Time kill curves (TKC) were performed with ATCC-29213 at drug concentrations above and below the respective minimum inhibitory concentrations (MIC). Mutation prevention concentration was determined for each drug formulation against ATCC-29213. All experiments were performed in triplicate. Mutant colonies from mutation prevention concentration (MPC) experiments were genotypically tested by sequence analysis. RESULTS MIC ratios between contiguous originator and generic drugs were similar for each isolate. No visual differences were observed in TKCs between originator and generic substances. The MPC did not differ between different formulations of the same substance. Although sequence analysis of mutant colonies revealed genomic differences compared with the original ATCC-29213, no differences in mutation frequencies were observed between clinical isolates and ATCC-29213 treated with originator or generic substances. CONCLUSIONS Similar antimicrobial activity and pathogen mutation prevention was observed between contiguous substances. These results support the interchangeability of generic and originator drug formulations with the same active ingredient.
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Affiliation(s)
- Felix Bergmann
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria; Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria
| | | | | | - Sabine Eberl
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria
| | - Werner Ruppitsch
- AGES - Austrian Agency for Health and Food Safety, Institute of Medical Microbiology and Hygiene, Vienna, Austria
| | - Sarah Lepuschitz
- AGES - Austrian Agency for Health and Food Safety, Institute of Medical Microbiology and Hygiene, Vienna, Austria
| | - Markus Zeitlinger
- Medical University of Vienna, Department of Clinical Pharmacology, Vienna, Austria.
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Al Zoubi S, Gharaibeh L, Al-Masri B, Alsahele AB, AL-Masaeid B. Generic switching: Do future physicians in Jordan have enough knowledge and a positive attitude? Front Pharmacol 2022; 13:1037112. [PMID: 36561340 PMCID: PMC9763699 DOI: 10.3389/fphar.2022.1037112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Generic switching is a policy that has shown success in minimising pharmaceutical costs. It has also been used to mitigate recurrent and sudden drug shortages. Not all countries have policies that allow pharmacists to switch to generic drugs independently. In Jordan, only pharmacists at Ministry of Health hospitals automatically switch to generics if doctors had not already done INN prescribing. Objectives: This study targeted medical students to assess their experience with generic switching as patients, their knowledge of the subject as students, and their attitude towards it as future prescribers and policymakers. Methods: This is a descriptive, cross-sectional study conducted online. Eligibility criteria were being a fourth, fifth, or sixth-year medical school student enrolled at any of the six Jordanian universities. The questionnaire was developed by the researchers after a careful review of the relevant literature. Results: Three hundred and ninety students responded to the online questionnaire. Most participants were females (244, 62.6%), senior students in their final (6th) year (162, 41.5%) and with very good academic achievement (166, 42.6%). The highest knowledge scores concerned patient rights (0.73/1.00), followed by knowledge about monitoring after generic switching (0.66/1.00), and patients with known drug allergies (0.66/1.00). Almost half of the participants believe that pharmacists should not be given the right to do generic switching and only 16% stated that they would choose generic drugs if they needed treatment in the future. Multivariate linear regression analysis showed that significant predictors of knowledge were gender, GPA, and family income. No correlations were found between participants' knowledge scores and their attitudes towards giving pharmacists the right to independently switch drugs, or whether they would accept a substitute from pharmacists rather than having to refer to the physician. Conclusion: Medical students in Jordan lack sufficient knowledge about generic switching. Students need to be more aware of the current policies and regulations of this practice, and the role of each healthcare worker involved in it. They also need to have a more positive attitude toward generic drugs and generic switching practice to facilitate its future implementation.
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Affiliation(s)
- Sura Al Zoubi
- Department of Basic Medical Sciences, School of Medicine, Al-Balqa Applied University, As-Salt, Jordan
| | - Lobna Gharaibeh
- Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Batool Al-Masri
- School of Medicine, Al-Balqa Applied University, As-Salt, Jordan
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El-Harakeh A, Haley SJ. Improving the availability of prescription drugs in Lebanon: a critical analysis of alternative policy options. Health Res Policy Syst 2022; 20:106. [PMID: 36209085 PMCID: PMC9547632 DOI: 10.1186/s12961-022-00921-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/21/2022] [Indexed: 11/23/2022] Open
Abstract
The economic downfall in Lebanon and the destruction of the Beirut Port have had a crippling effect on all players in the health sector, including hospitals, healthcare providers, and the pharmaceutical and medical supply industry. The outbreak of COVID-19 has further aggravated the crisis. To address the challenges facing the pharmaceutical industry, Lebanon must create a stable and secure source of prescription drug production. Two alternative approaches are presented to address the crisis: (1) amending the subsidy system and supporting local pharmaceutical production, and (2) promoting the prescription and use of generic drugs. Investing in local production is promising and can lead to establishing trust in the quality of drugs produced locally. These efforts can be complemented by promoting the prescription and use of generic drugs at a later stage, after having had established a well-operating system for local drug production.
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Affiliation(s)
- Amena El-Harakeh
- Department of Community Health and Social Sciences, City University of New York's Graduate School of Public Health and Health Policy, 55 West 125th Street, New York, NY, 10027, United States of America.
| | - Sean J Haley
- Department of Health Policy and Management, City University of New York's Graduate School of Public Health and Health Policy, 55 West 125th Street, New York, NY, 10027, United States of America
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Rainio R, Ahonen R, Lämsä E, Timonen J. Factors facilitating and hindering counselling about generic substitution and a reference price system in community pharmacies - a survey among Finnish dispensers. BMC Health Serv Res 2022; 22:1130. [PMID: 36071413 PMCID: PMC9454142 DOI: 10.1186/s12913-022-08477-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pharmacies play the key role in implementing generic substitution (GS) and counselling customers about it. This study aimed to explore dispensers’ perceptions of the factors that facilitate or hinder counselling customers on GS and the reference price system (RPS) in community pharmacies. It also studied dispensers’ opinions about the benefits and problems of these systems and discusses them from the counselling point of view. Methods A postal survey was conducted among Finnish community pharmacy dispensers in spring 2018. The research questions were studied through open-ended questions and analyzed both qualitatively and quantitatively. The questions were analyzed first with inductive content analysis by two researchers independently. The responses were encoded and categorized according to the analytical framework, which was inductively developed alongside the analysis. The categorized responses were further analyzed using frequencies and percentages. Results The response rate was 50.8% (n = 498). Of the respondents, 75.9% reported factors that facilitated counselling about GS and RPS. The most commonly mentioned factors included customers’ characteristics (36.5%), the information systems used in the pharmacy (28.3%), and the features of interchangeable medicines (21.7%). Of the respondents, 89.0% reported factors that hindered counselling, of which customers’ characteristics (45.8%), the unavailability of medicines and other availability issues (32.5%), the features of interchangeable medicines (22.6%) and time pressure in the pharmacy (22.1%) were the most commonly reported. The benefits of the systems focused on cost savings for customers and society (74.4%). The most commonly reported problems concerned medicine availability (31.9%), changes in medicine prices and in reference price band (28.9%), as well as how GS is time-consuming and increases workload (24.2%). Conclusions Finnish dispensers reported more hindering than facilitating factors in GS and RPS counselling. Customers’ characteristics were the most often mentioned in both cases. Customers’ knowledge could be increased by providing information and education. However, developing simpler regulations for GS and RPS, intelligent assisting software, and solutions for secured medicine availability would facilitate implementation of GS. Simplified price counselling would also guarantee the time needed and focus on instructions on the correct and safe use of medicines. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08477-2.
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Affiliation(s)
- Riikka Rainio
- School of Pharmacy, Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, PO Box 1627, FI-70211, Kuopio, Finland.
| | - Riitta Ahonen
- School of Pharmacy, Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, PO Box 1627, FI-70211, Kuopio, Finland
| | - Elina Lämsä
- School of Pharmacy, Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, PO Box 1627, FI-70211, Kuopio, Finland
| | - Johanna Timonen
- School of Pharmacy, Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, PO Box 1627, FI-70211, Kuopio, Finland
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Bergmann F, Wulkersdorfer B, Oesterreicher Z, Bauer M, Al Jalali V, Nussbaumer-Pröll A, Wölfl-Duchek M, Jorda A, Lackner E, Reiter B, Stimpfl T, Ballarini N, König F, Zeitlinger M. Comparison of pharmacokinetics and stability of generics of cefepime, linezolid and piperacillin/tazobactam with their respective originator drugs: an intravenous bioequivalence study in healthy volunteers. J Antimicrob Chemother 2022; 77:3086-3092. [PMID: 36039038 DOI: 10.1093/jac/dkac285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The efficacy and quality of generic antibacterial drug formulations are often questioned by both healthcare specialists and patients. Therefore, the present study investigated the interchangeability of generic drugs with their originators by comparing bioequivalence parameters and stability data of generic cefepime, linezolid and piperacillin/tazobactam with their respective originator drugs. METHODS In this open-label, randomized, crossover bioequivalence study, three groups of 12 healthy volunteers each received a single intravenous infusion of either 2 g of cefepime or 4.5 g of piperacillin/tazobactam and two generic formulations, or 600 mg of linezolid and one generic formulation. Plasma sampling was performed, with a 5 day washout period between study days. Stability was tested by storing reconstituted generic and originator products according to their own storage specifications and those of the comparator products. All concentrations were measured by LC-MS. RESULTS Similar ratios of generic/originator (90% CI) Cmax were observed for Cefepime-MIP/Maxipime [93.7 (88.4-99.4)], Cefepime Sandoz/Maxipime [95.9 (89.1-103.2)], Linezolid Kabi/Zyvoxid [104.5 (91.1-119.9)], Piperacillin Kabi/Tazobac [95.9 (90.4-101.7)], Piperacillin Aurobindo/Tazobac [99.7 (84.9-104.7)], Tazobactam Kabi/Tazobac [93.4 (87.4-99.8)] and Tazobactam Aurobindo/Tazobac [97.4 (89.7-105.8)]. Accordingly, similar ratios of AUC0-t were observed for Cefepime-MIP/Maxipime [91.1 (87.6-94.8)], Cefepime Sandoz/Maxipime [97.9 (92.5-103.5)], Linezolid Kabi/Zyvoxid [99.7 (93.3-106.6)], Piperacillin Kabi/Tazobac [92.2 (88.3-96.3)], Piperacillin Aurobindo/Tazobac [99.9 (97.0-102.8)], Tazobactam Kabi/Tazobac [91.4 (86.4-96.7)] and Tazobactam Aurobindo/Tazobac [98.8 (94.3-103.6)]. Stable and similar concentrations were measured for all contiguous substances, regardless of storage conditions. CONCLUSIONS Compared with their respective originator drugs, generic cefepime, linezolid and piperacillin/tazobactam met the predetermined bioequivalence criteria. All formulations were stable under the storage conditions of their respective comparators.
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Affiliation(s)
- Felix Bergmann
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria.,Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Beatrix Wulkersdorfer
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Zoe Oesterreicher
- Medical University of Vienna, Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Martin Bauer
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Valentin Al Jalali
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Alina Nussbaumer-Pröll
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Michael Wölfl-Duchek
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Anselm Jorda
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Edith Lackner
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Birgit Reiter
- Medical University of Vienna, Clinical Institute of Laboratory Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Thomas Stimpfl
- Medical University of Vienna, Clinical Institute of Laboratory Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Nicolas Ballarini
- Medical University of Vienna, Clinical Institute of Laboratory Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Franz König
- Medical University of Vienna, Center for Medical Statistics, Informatics, and Intelligent Systems, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Markus Zeitlinger
- Medical University of Vienna, Department of Clinical Pharmacology, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Qu J, Zuo W, Took RL, Schafermeyer KW, Lukas S, Wang S, Du L, Liu X, Gao Y, Li J, Pan H, Du X, Mei D, Zhang B. A nationwide survey exploring physicians’ and pharmacists’ knowledge, awareness and perceptions regarding generic medicines in China. BMC Health Serv Res 2022; 22:1069. [PMID: 35987631 PMCID: PMC9392939 DOI: 10.1186/s12913-022-08438-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Generic medicines substitution is an important means to control rapid growth of pharmaceutical expenditures for the healthcare system in China. Acceptance and utilization of generic medicines is highly influenced by healthcare providers’ perceptions. This study aimed to compare the knowledge, awareness and perceptions of generic medicines between physicians and pharmacists in China. Methods We used an online, cross-sectional survey across China. The questionnaire explored four sections: demographic characteristics, assessment of the participants’ knowledge and awareness of generic medicines, perceptions of generic medicines and generic substitution practices. Chi-square or Mann–Whitney-U tests were applied to compare differences between physicians and pharmacists. P-values < 0.05 were considered significant. Results A total of 1644 physicians and 4187 pharmacists participated. Most physicians (82.8%, n = 1362) and pharmacists (89.8%, n = 3760) correctly identified the definition of generic medicines. A similar percentage of physicians and pharmacists agreed that approved generic medicines are as effective (64.1% vs 68.2%) or safe (63.8% vs 69.1%) as brand-name medicines. Most physicians and pharmacists (67.6% vs 71.0%) supported the policy of generic substitution. In practice, 79.4% (n = 1305) of physicians reported that they had prescribed generic medicines. More than 78% of respondents reported an obvious increase in the number of generic medicines prescribed in their medical institutions. The majority of physicians and pharmacists identified lack of trust regarding efficacy and safety of generic medicines and the difficulty of changing patients’ preference as top challenges in generic substitution. Conclusions Both physicians and pharmacists surveyed had adequate knowledge of generic medicines, and hold positive attitude towards generics and generic substitution. Efficacy and safety are key factors related to prescribing or dispensing generic medicines. Various policies and regulations should be taken to encourage successful generic substitution. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08438-9.
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Huang T, Bai L, Wushouer H, Wang Z, Yang M, Lin H, Shen P, Guan X, Shi L. Clinical Outcome and Medical Cost of Originator and Generic Antihypertensive Drugs: A Population-Based Study in Yinzhou, China. Front Pharmacol 2022; 13:757398. [PMID: 35295329 PMCID: PMC8920543 DOI: 10.3389/fphar.2022.757398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The substitution of generic drugs can effectively alleviate the rapid growth of drug costs; however, the clinical effectiveness and medical costs of originator products and generics were barely studied in China. Objectives: To compare the effectiveness of antihypertensive drugs and hypertension-related medical costs between originator and generic initiators in Yinzhou, China. Methods: We conducted a population-based retrospective cohort study using the Chinese Electronic Health Records Research in Yinzhou (CHERRY), from July 1, 2011, to December 31, 2018. Hypertension patients initiating with originator products were compared with patients initiating with generic counterparts. We used 1:1 propensity score matching to pair the two groups based on sociodemographic, clinical, and health service utilization variables. Cox proportional regression was adopted to compare the rate of hospitalization for hypertension-related cardiovascular disease between matched originator and generic initiators. Wilcoxon matched-pairs signed-rank test was used to compare annual hypertension-related medical costs. Results: Matched pairs (10,535) of patients were included in the comparative study of originator products and generics, corresponding to seven antihypertensive drugs including amlodipine, felodipine, nifedipine, irbesartan, losartan, valsartan, and metoprolol. The average age of patients included in the analysis was around 60 years (originator vs. generics initiators: from 59.0 vs. 59.1 years in losartan to 62.9 vs. 63.6 years in nifedipine). Higher hospitalization rates among originator initiators were observed for three calcium channel blockers (hazard ratio[95% CI]: amlodipine, 3.18[1.43, 7.11]; felodipine, 3.60[1.63, 7.98]; and nifedipine, 3.86[1.26, 11.81]; respectively). The remaining four out of seven drugs of the clinical endpoint estimates showed comparable outcomes between originator products and generics (hazard ratio[95% CI]: irbesartan, 1.19[0.50, 2.84]; losartan, 1.84[0.84, 4.07]; valsartan, 2.04[0.72, 5.78]; and metoprolol, 1.25[0.56, 2.80]; respectively). Higher median annual hypertension-related medical costs were observed in originator initiators (all p < 0.001), except for metoprolol (p = 0.646). Conclusion: We observed comparable or even better clinical outcomes and less medical cost associated with the use of antihypertensive generics compared to originator counterparts. This could help increase patient and provider confidence in the efficacy of generic medicines to manage hypertension diseases.
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Affiliation(s)
- Tao Huang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Lin Bai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Haishaerjiang Wushouer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Zhiyuan Wang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Mingchun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Hongbo Lin
- Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Peng Shen
- Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.,International Research Center for Medicinal Administration, Peking University, Beijing, China
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11
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Niyongere J, Welty TE, Bell MW, Consalvo D, Hammond C, Leung H, Patsalos PN, Ryan M, Suansanae T, Zhou D, Zuellig H. Barriers to Generic Antiseizure Medication Use: Results of a Global Survey by the International League Against Epilepsy Generic Substitution Task Force. Epilepsia Open 2022; 7:260-270. [PMID: 35124903 PMCID: PMC9159248 DOI: 10.1002/epi4.12583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/20/2022] Open
Abstract
The objective of this study was to identify and quantify barriers to generic substitution of antiseizure medications (ASM). A questionnaire on generic ASM substitution was developed by the International League Against Epilepsy (ILAE) Task Force on Generic Substitution. Questions addressed understanding of bioequivalence, standards for generic products, experiences with substitution, and demographic data. The survey was web‐based and distributed to ILAE chapters, their membership, and professional colleagues of task force members. Comparisons in responses were between ILAE regions and country income classification. A total of 800 individuals responded, with 44.2% being from the Asia‐Oceania ILAE Region and 38.6% from European Region. The majority of respondents had little or no education in generic substitution or bioequivalence. Many respondents indicated lack of understanding aspects of generic substitution. Common barriers to generic substitution included limited access, poor or inconsistent quality, too expensive, or lack of regulatory control. Increase in seizures was the most common reported adverse outcome of substitution. Of medications on the World Health Organization Essential Medication list, problems with generic products were most frequent with carbamazepine, lamotrigine, and valproic acid. Several barriers with generic substitution of ASM revolved around mistrust of regulatory control and quality of generic ASM. Lack of education on generic substitution is also a concern. Generic ASM products may be the only option in some parts of the world and efforts should address these issues. Efforts to address these barriers should improve access to medications in all parts of the world.
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Affiliation(s)
- Jenna Niyongere
- MercyOne Des Moines, Doctor of Pharmacy student, College of Pharmacy and Health Sciences at Drake University, Iowa, USA
| | - Timothy E Welty
- College of Pharmacy and Health Sciences, Drake University Des Moines, Iowa, USA
| | - Michelle W Bell
- Columbia University Irving Medical Center, Columbia University, New York City, New York, USA
| | - Damian Consalvo
- Epilepsy Section, Ramos Mejía Hospital, University of Buenos Aires, Institute of Neurology and Neurosurgery, Sanatorio de Los Arcos, Buenos Aires, Argentina
| | - Charles Hammond
- Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Howan Leung
- The Chinese University of Hong Kong, Hong Kong, China
| | - Philip N Patsalos
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, England
| | - Melody Ryan
- College of Pharmacy, University of Kentucky, Lexington, Kentucky, USA
| | - Thanarat Suansanae
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Dong Zhou
- Sichuan University, Chengdu, Sichuan, China, Department of Neurosciences, College of Medicine, San Beda University, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Hazel Zuellig
- Sichuan University, Chengdu, Sichuan, China, Department of Neurosciences, College of Medicine, San Beda University, College of Public Health, University of the Philippines Manila, Manila, Philippines
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12
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Qu J, Zuo W, Wang S, Du L, Liu X, Gao Y, Li J, Pan H, Du X, Mei D, Took RL, Schafermeyer KW, Lukas S, Zhang B. Knowledge, perceptions and practices of pharmacists regarding generic substitution in China: a cross-sectional study. BMJ Open 2021; 11:e051277. [PMID: 34663661 PMCID: PMC8524276 DOI: 10.1136/bmjopen-2021-051277] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To evaluate pharmacists' knowledge, perceptions and practices towards generic substitution in the 11 pilot locations in China. DESIGN An online cross-sectional survey using questionnaires was conducted. A convenience sampling technique was implemented to recruit pharmacists. SETTING AND PARTICIPANTS The study took place in medical institutions of 11 pilot locations that participated in the pilot national centralised procurement programme in 2019. Two thousand two hundred and ninety-one pharmacists including hospital pharmacists or community pharmacists based on health-systems or clinics participated in the study. RESULTS Most of the participants had the good knowledge of requirements for evaluating the quality and efficacy of generic drugs (n=2118; 92.4%), and the definition of generic drugs (n=2078; 90.7%). In terms of perceptions, 67.3% of respondents were of the opinion that generic drugs are equally as effective as the brand-name drugs, and 69.0% of respondents were of the opinion that generic drugs are as safe as brand equivalents. A high percentage of participants supported the policy of generic substitution (n=1634; 71.4%). A significant positive correlation was demonstrated between total knowledge score and total perception score (ρ=0.267; p<0.001). Efficacy, safety and the direction of national policies and hospital regulations were the main factors affecting pharmacists' willingness to dispense generic drugs. CONCLUSIONS The study identified gaps in respondents' knowledge and perceptions of generic substitution. Pharmacists who are more knowledgeable in generic drugs tend to hold a more supportive attitude towards generic substitution. Although it appeared that pharmacists in China have largely accepted generic substitution, they still have concerns regarding the reliability and quality of generic drugs. The current issues need to be addressed for the realisation of the true value of generic drugs as part of the country's healthcare cost-containment strategy as well as the implementation of generic substitution policy in China.
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Affiliation(s)
- Jinghan Qu
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Wei Zuo
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Shaohong Wang
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Liping Du
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Xin Liu
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Yang Gao
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Jiantao Li
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Hui Pan
- Department of Medical Administration, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Xiaoli Du
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Dan Mei
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Roxane L Took
- Department of Pharmacy Practice, St. Louis College of Pharmacy, St Louis, Missouri, USA
| | - Kenneth W Schafermeyer
- Department of Pharmaceutical and Administrative Sciences, St. Louis College of Pharmacy, St Louis, Missouri, USA
| | - Stephanie Lukas
- Department of Pharmaceutical and Administrative Sciences, St. Louis College of Pharmacy, St Louis, Missouri, USA
| | - Bo Zhang
- Department of Pharmacy, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
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13
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Plante-Lepage R, Voyer P, Carmichael PH, Kröger E. A nursing mentoring programme on non-pharmacological interventions against BPSD: Effectiveness and use of antipsychotics-A retrospective, before-after study. Nurs Open 2021; 9:181-188. [PMID: 34612586 PMCID: PMC8685876 DOI: 10.1002/nop2.1042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/19/2021] [Accepted: 08/04/2021] [Indexed: 11/18/2022] Open
Abstract
Behavioural and psychological symptoms of dementia (BPSD) are common and have significant implications for patients and caregivers. Non‐pharmacological interventions (NPI) have shown to be effective in the management of BPSD. However, the use of antipsychotics to treat BPSD remains ubiquitous. This retrospective, before–after study aimed to examine whether a nurse mentoring programme promoting NPI for BPSD management had a significant association with the use of antipsychotics in older adults with major neurocognitive disorders residing in different settings. Results obtained from the medical files of 134 older adults having benefitted from the mentoring programme demonstrate that this intervention significantly reduced BPSD. The effect on antipsychotics use was modest: a 10% reduction in the use of antipsychotics has been observed among patients for which the NPI were effective. However, the use of antipsychotics remained widespread despite the nursing recommendations of the mentoring team of the Center of Excellence on Aging in Quebec (CEVQ).
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Affiliation(s)
| | - Philippe Voyer
- Faculté des Sciences Infirmières, Université Laval, Laval, QC, Canada.,Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada.,Faculté des Sciences Infirmières, Université Laval, Québec, QC, Canada
| | - Pierre-Hugues Carmichael
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada.,Faculté des Sciences Infirmières, Université Laval, Québec, QC, Canada
| | - Edeltraut Kröger
- Centre d'Excellence sur le Vieillissement de Québec, Québec, QC, Canada.,Faculté des Sciences Infirmières, Université Laval, Québec, QC, Canada.,Faculté de Pharmacie, Université Laval, Québec, QC, Canada
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14
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AlSwayeh R, Alvi SN, Hammami MM. Quality assessment of nine paracetamol 500 mg tablet brands marketed in Saudi Arabia. BMC Res Notes 2021; 14:254. [PMID: 34193274 PMCID: PMC8247153 DOI: 10.1186/s13104-021-05672-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/24/2021] [Indexed: 12/03/2022] Open
Abstract
Objective To evaluate in-vitro quality of paracetamol 500 mg tablet brands marketed in Saudi Arabia. Results Two reference (R1 and R2) and seven generic (G1-G7) brands were commercially available. Four brands were single-drug, containing paracetamol only (R1, G1-G3) and five contained additional active ingredients (R2, G4-G7). All brands were immediate-release. Weight variation (n = 20, range as percent difference from mean), active substance content (n = 20, mean (SD) as percent difference from label), breaking force (n = 10, mean (SD)), and friability (n = 20, as percent weight loss) ranged from 97 to 102%, 96.1% (2.9%) to 99.8% (1.1%), 9.9 (0.4) to 21.0 (0.9) kg, and 0.017% to 0.809%, respectively. Disintegration (water medium) time (n = 6, minute: second) ranged from 02:35–03:09 to 12:49–13:10. Dissolution (phosphate buffer, pH 5.8) profile showed a mean release at 30 min of 87% to 97% of label content, with seven brands passing stage-1 (≥ 85% for each of 6 test units) and two passing stage-2 (mean of 12 test units ≥ 85%) criteria. Despite statistically significant differences between R1 and R2 and some of their corresponding generic brands in active substance content, breaking force, and amount dissolved at 30 min, all nine brands met the pre-specified quality standards. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05672-y.
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Affiliation(s)
- Reem AlSwayeh
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia
| | - Syed N Alvi
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia
| | - Muhammad M Hammami
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia. .,Alfaisal University College of Medicine, Riyadh, Saudi Arabia.
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15
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Oncu S, Bayram D, Aydin V, Isli F, Aksoy M, Akici A, Ucku R, Gelal A. Knowledge, opinions and attitudes of primary care physicians about generic drugs: a cross-sectional study. Fam Pract 2021; 38:272-279. [PMID: 33340330 DOI: 10.1093/fampra/cmaa138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Generic drug (GD) use is affected by many factors, including physicians' approach. OBJECTIVE This study aimed to investigate the knowledge, opinions and attitudes of primary care physicians (PCPs) about GDs and potentially associated factors. METHODS An adequately representative sample (n = 354) of PCPs was determined via stratified and simple random sample selection method in this descriptive, cross-sectional study. The research data were collected through a face-to-face 40-item survey, where the knowledge, opinions and attitudes about GDs were questioned. The prescribing percentage of GDs overall was also examined. RESULTS The survey was completed by 305 PCPs (mean age: 49.2 ± 7.9 years; 57.4% male). The rate of correct responses about GDs was 67.6% for basic knowledge and 46.6% for the development process. The percentages of PCPs who declared that GDs were 'less efficacious', 'of lower quality' and 'less safe' than original drugs were 65.2%, 53.4% and 35.4%, respectively. More than half (60.3%) of the PCPs declared not to pay attention to whether the drug is generic while prescribing. It was observed that, as the knowledge level of the physicians increased, negative opinions and prescribing attitudes regarding the effectiveness, quality and safety of the GDs decreased. The rate of GD prescribing (51.6%) in Izmir was lower than the rest of the country (54.6%; P < 0.001). CONCLUSION This study shows that the knowledge of PCPs about GDs is generally inadequate, which reflects negatively on their opinions and attitudes regarding the use of GDs. Educational activities can help establish awareness that GDs can be used without doubt of their effectiveness, quality and safety.
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Affiliation(s)
- Seyma Oncu
- Department of Medical Pharmacology, Dokuz Eylul University School of Medicine, Izmir
| | - Dilara Bayram
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul
| | - Volkan Aydin
- Department of Medical Pharmacology, International School of Medicine, Istanbul Medipol University, Istanbul
| | - Fatma Isli
- Turkish Medicines and Medical Devices Agency, Ministry of Health, Ankara
| | - Mesil Aksoy
- Turkish Medicines and Medical Devices Agency, Ministry of Health, Ankara
| | - Ahmet Akici
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul
| | - Reyhan Ucku
- Department of Public Health, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ayse Gelal
- Department of Medical Pharmacology, Dokuz Eylul University School of Medicine, Izmir
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16
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Niraj N, Shafiq N, Kaushik S, Mothsara C, Garg G, Malhotra S. Naturalistic Evaluation of Prescription Pattern in Glaucoma Clinic of a Tertiary Care Hospital: A Developing Country's Perspective. J Pharm Bioallied Sci 2021; 13:83-87. [PMID: 34084052 PMCID: PMC8142915 DOI: 10.4103/jpbs.jpbs_324_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/06/2020] [Accepted: 06/18/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Glaucoma is a chronic, gradual and progressive eye disorder characterized by visual loss and involving the typical changes in optic nerves and associated structures. Currently, the mainstay treatment lies in the reduction of intraocular pressure (IOP) involving the usage of two or three medications concurrently. However, prescription pattern of antiglaucoma drugs remains largely unstudied so far. Therefore, there is a dire need of drug utilization studies to ensure rational prescribing for better treatment outcomes. Aim: This study was conducted to assess the prescription pattern in glaucoma patients to encourage rational use of drugs. Materials and Methods: The pertinent data of confirmed glaucoma patients were entered in a predesigned case record form (CRF) including patient demographic details, type of glaucoma, number of drug prescribed, drug dosage and dosage formulation with prior patient consent, and finally, the data were analyzed using Microsoft Excel. Results: A total of 247 glaucoma patients were recorded in the study. The mean SD number of drugs per prescription was 2.18 (1.68). Monotherapy was prescribed to 72 (29.15%) patients, and the most common monotherapy prescribed was timolol, whereas in fixed-dose combinations (FDCs), brimonidine and timolol FDCs were most commonly encountered. Furthermore, prescriptions consisting of generic drugs only and prescribed as per the National List of Essential Medicines (NLEM) were 48 (19.43%) and 41 (16.59%), respectively. Conclusion: This study showed the judicious use of medications in tune with principles of rational drug use in our center, and the rationale practices can be extended to the peripheral centers of the country for better drug utilization.
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Affiliation(s)
- Niraj Niraj
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nusrat Shafiq
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushmita Kaushik
- Glaucoma services, Advance Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chakrant Mothsara
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Garg
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Samir Malhotra
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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17
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Charan J, Saxena D, Chaudhri M, Dutta S, Kaur RJ, Bhardwaj P. Opinion of primary care physicians regarding prescription of generic drugs: A Cross-sectional study. J Family Med Prim Care 2021; 10:1390-1398. [PMID: 34041184 PMCID: PMC8140226 DOI: 10.4103/jfmpc.jfmpc_2157_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/02/2020] [Accepted: 01/05/2021] [Indexed: 12/01/2022] Open
Abstract
Background: Generics are low-cost alternatives of the existing approved branded drugs. The aim of this work was to study knowledge and perception about generic drugs among the doctors practicing in government and private healthcare sectors. Methods: A cross-sectional study was conducted with a prevalidated questionnaire. Physicians working in government and private healthcare sectors were asked to fill the survey form after obtaining written informed consent. Descriptive analysis was used. Results: Of 240, 11.6% of primary care physicians could identify all the correct statements regarding generic drugs and 57% physicians agreed or strongly agreed that doctors should prescribe only generic drugs. Substandard quality (24.4%) and less effectiveness (35.6%) of generics was cited major reason for low use. Majority (76.1%) believed that patients will accept substitution of branded with generics but 21% either did not or rarely inform patients regarding generics. Only 11.7% considered generics has low efficacy as compared to branded drugs but majority (57.4%) denied the interchangeability of generics. Majority were aware about the Jan Aushadhi scheme (79.3%) and Indian Medical Council Act (Professional conduct, Etiquette and Ethics) (76.8%). For personal use, 45.6% preferred generics. Around 44% agreed/strongly agreed for pharmacist's right to substitute branded drugs with generics but private practicing physicians opted against it. Conclusion: Knowledge and acceptance of generic drugs is still low amongst the doctors. Efforts need to be done increase the awareness and acceptability.
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Affiliation(s)
- Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepak Saxena
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Mayur Chaudhri
- Department of Pharmacology, Govt. Medical College, Surat, Gujarat, India
| | - Siddhartha Dutta
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rimple Jeet Kaur
- Department of Pharmacology, S. N. Medical College, Jodhpur, Rajasthan, India
| | - Pankaj Bhardwaj
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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18
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Hammami MM, AlSwayeh R, Hussein RF. Pharmaceutical quality of seven brands of diclofenac tablet on the Saudi market. BMC Res Notes 2020; 13:548. [PMID: 33243292 PMCID: PMC7694918 DOI: 10.1186/s13104-020-05385-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022] Open
Abstract
Objective We previously reported the pharmaceutical quality of eight brands of 50 mg enteric-coated diclofenac sodium tablet available on the Saudi market. Here, we assess the quality of reference (R1) and four generic (G1–G4) brands of 50 mg immediate-release diclofenac potassium tablet and of reference (R2) and generic (G5) brands of 100 mg sustained-release diclofenac sodium tablet. Results Weight variation (range as % difference from mean), active substance content (mean (SD) as % difference from label), breaking force [mean (SD)], and friability (as % weight loss) were 95–104% and 99–102%, 100.9% (3.4%) and 105.6 (4.2%), 12.2 (1.3) and 12.9 (1.8) kg, and 0.0014% and 0.0012%, for R1 and R2, respectively. For G1-G5, they were ≤ ± 2%, 98.8% (2.7%) to 109.2% (3.8%), 6.4 (0.6) to 13.3 (1.0) kg, and 0.0007% to 0.0261%, respectively. R1 and G1-G4 disintegrated within 04:50–17:20 min: seconds and released a mean of 89–100% of label active substance content by 60 min in buffer (pH 6.8). R2 and G5 did not disintegrate or dissolve in 0.1 N HCl for 2 h, disintegrated in buffer (pH 6.8) in 01:58–02:15 h: minutes, and fulfilled dissolution criteria (pH 7.5) for both United States Pharmacopoeia test-1 and test-2. Thus all seven brands met pre-specified quality criteria.
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Affiliation(s)
- Muhammad M Hammami
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia. .,Alfaisal University College of Medicine, Riyadh, Saudi Arabia.
| | - Reem AlSwayeh
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia
| | - Rajaa F Hussein
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia
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19
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Hammami MM, Hussein RF, AlSwayeh R, Alvi SN. Eight enteric-coated 50 mg diclofenac sodium tablet formulations marketed in Saudi Arabia: in vitro quality evaluation. BMC Res Notes 2020; 13:428. [PMID: 32928294 PMCID: PMC7491129 DOI: 10.1186/s13104-020-05270-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/04/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate in vitro quality of enteric-coated 50 mg diclofenac sodium tablet formulations on Saudi market. RESULTS A reference and seven generic (G1-7) formulations were commercially available in December 2019/January 2020 and were assessed within 25-75% of manufacture-expiration period. Weight variation (range as% difference from mean, n = 20), active substance content (ASC, mean (SD) as% difference from label, n = 20), hardness (mean (SD), n = 10), and friability (% weight loss, n = 20) were 97-103%, 102.0% (3.4%), 15.4 (1.1) kg, and 0.24%, respectively, for the reference. For G2-7, they were ≤ ±5%, 98.6% (4.0%) to 109.9% (1.8%), 11.9 (0.9) to 18.3 (0.8) kg, and ≤ 0.00 to 0.75%, respectively. G1 ASC, hardness, and friability were 111.3% (1.7%), 20.1 (1.7) kg, and 1.10%, respectively. Disintegration time (n = 6) and dissolution profile (n = 8) were also determined. No formulation disintegrated or released ˃ 0.1% of label ASC in 0.1 N HCl for 2 h. The reference disintegrated in 15:00 min:seconds and released a mean (range) of 100% (99-103%) of label ASC by 45 min in phosphate buffer (pH = 6.8). G1-7 disintegrated in 8:53 to 20:37 min:seconds and released 81% (69-90%) (G1) to 109%. Except for borderline performance of G1, all formulations passed in vitro quality tests according to United States Pharmacopoeia.
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Affiliation(s)
- Muhammad M Hammami
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, MBC 03, PO Box # 3354, Riyadh, 11211, Saudi Arabia. .,Alfaisal University College of Medicine, Riyadh, Saudi Arabia.
| | - Rajaa F Hussein
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, MBC 03, PO Box # 3354, Riyadh, 11211, Saudi Arabia
| | - Reem AlSwayeh
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, MBC 03, PO Box # 3354, Riyadh, 11211, Saudi Arabia
| | - Syed N Alvi
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, MBC 03, PO Box # 3354, Riyadh, 11211, Saudi Arabia
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Sammut Bartolo N, Ignas L, Wirth F, Attard Pizzuto M, Vella Szijj J, Camilleri L, Serracino-Inglott A, Azzopardi LM. Public perception of generic medicines in Malta. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2020. [DOI: 10.1111/jphs.12366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AbstractObjectivesTo assess the perception of generic medicines among the general public in Malta.MethodsA self-administered questionnaire was developed to assess knowledge, attitudes and use of generic medicines. The questionnaire was disseminated to a sample of the public recruited by convenience sampling in five localities in Malta. Descriptive statistics were undertaken.Key findingsA total of 228 participants completed the questionnaire; 54% were female, 42% were ≥60 years old, and 37% had up to secondary education level. Sixty-one per cent of the participants were aware of the correct definition of a generic medicine, and 55% stated that they had previously used generic medicines. Twenty per cent of the participants had never used generic medicines since they perceived them to be inferior in quality or less effective compared to their originator counterparts. Fifty-four per cent of the participants would switch to a generic medicine if the originator product was out-of-stock and 38% would pay between 1% and 20% less for a generic medicine compared to the originator product.ConclusionsParticipants in this study exhibited a positive overall perception regarding generic medicines, demonstrating improvement in perception from a previous local study. The majority of participants were knowledgeable about generic medicines, had previously used generic medicines and would switch to a generic medicine if the originator product was not in stock.
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Affiliation(s)
| | - Louella Ignas
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Francesca Wirth
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Maresca Attard Pizzuto
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Janis Vella Szijj
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Liberato Camilleri
- Department of Statistics and Operations Research, Faculty of Science, University of Malta, Msida, Malta
| | | | - Lilian M Azzopardi
- Department of Pharmacy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Decreasing utilization and increasing prices of brand-name oral contraceptive pills: Implications to societal costs and market competition. PLoS One 2020; 15:e0234463. [PMID: 32525965 PMCID: PMC7289391 DOI: 10.1371/journal.pone.0234463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/15/2020] [Indexed: 11/25/2022] Open
Abstract
The affordability of pharmaceuticals has been a major challenge in US health care. Generic substitution has been proposed as an important tool to reduce the costs, yet little is known how the prices of more expensive brand-name drugs would be affected by an increased utilization of generics. We aimed to examine the trend of overall utilization and the total costs of brand-name oral contraceptive pills (OCPs), the most widely used form of contraception, and its association with the pharmaceutical market concentration among the OCPs. Data from the Medical Expenditure Panel Survey (MEPS) 2011–2014, a nationally representative survey of healthcare utilization, were extracted on the utilization of generic and brand-name OCPs. A multiple logit regression analysis was conducted to assess the trend in utilization of brand-name OCPs over time. Total costs, including the costs to the payers and consumers, were synthesized. The Herfindahl-Hirschman Index (HHI), an index describing market concentration, was constructed, and a multiple regression analysis was conducted to evaluate the association between the brand-name OCP prices and the market share of individual brand-name drugs. The odds of utilizing brand-name drugs decreased steadily in 2012, 2013, and 2014 compared to 2012 (AOR 0.87, 0.73, 0.55, respectively, p<0.05) controlling for patient mix. Despite significant decline in total utilization, there was a 90% increase in the price of brand-name OCPs, resulting an 18% increase in revenue from 2011 to 2014 for the industry. During this time, pharmaceutical market concentration for OCPs increased (HHI increased from 1105 in 2011 to 2415 in 2014). Each percentage point increase in the market share by a brand-name OCPs was associated with a $3.12 increase in its price. Market mechanisms matter. Practitioners and policy makers need to take market mechanisms into account in order to realize the benefits of generic substitutions.
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Abstract
Determinants of placebo effects and placebo response can be considered from multiple intrinsic and extrinsic perspectives. Intrinsic factors may influence the patient and the clinician/researcher. Patient expectations and previous experiences are considered two of the major intrinsic determinants of placebo response. Other patient determinants include the neural systems under treatment/study, situational factors and reactions to the environment, and personality traits. Clinician/researcher determinants of placebo response include personality factors such as empathy, perceived expertise, the clinical relationship with the patient, and the clinician's belief in the efficacy of the treatment. Extrinsic determinants include the type of study design, influence of advertising or branding, and forces expressed by the cultural milieu. These determinants do not act in isolation, but rather form a complex interaction that ultimately impacts the promotion or deterrence of the placebo effect in clinical and research settings.
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Affiliation(s)
- Sharlet Anderson
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States.
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
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Pinho M. Prescribers’ and dispensers' views about generic medicines and international non-proprietary name prescribing – a mixed methods study in Portugal. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2020. [DOI: 10.1108/ijphm-12-2018-0064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis study aims to explore the views of pharmacy professionals (PPs) in Portugal about generic medicines and international non-proprietary name (INN) prescribing and compare them with the views of general practitioners (GPs).Design/methodology/approachA self-administered questionnaire was used to collect data from a sample of 185 community PPs and 85 GPs. Their perceptions were examined using a five-point Likert scale applied to statements focusing on five main topics of interest: motivation, safety, users’ perceptions and knowledge, advantages and disadvantages of generic medicines and INN prescribing. Daily experiences and suggestions for decreasing health and pharmaceutical expenses were explored through open-ended questions. Nonparametric tests were used to compare attitudes between both groups and to explore associations between the level of agreement and respondents’ demographic characteristics. Content analysis was used to categorize the answers to the open-ended questions.FindingsGenerally, GPs expressed more negative opinions toward generics and INN prescribing than PPs. GPs perceived generics as less effective, less safe, inferior in quality, more likely to cause side effects and believed that users do not trust them. Both groups believed that patients remain very confused and ill-informed about generics, only adhering to them because of their low cost and expressed concerns about the existence of an excessive number of generic medicines and the lack of patients’ responsibility toward medicines costs.Originality/valueTo the best of the authors’ knowledge, this study represents the first attempt to elicit and compare Portuguese GPs and PPs opinions concerning INN prescribing.
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Hohmann NS, Garza KB, Surry D, Hansen RA, Harris I, Kiptanui Z, Oguntimein O, Frost MM, Qian J. Healthcare provider opinions about a generic drug educational newsletter. Res Social Adm Pharm 2019; 16:1228-1236. [PMID: 31838057 DOI: 10.1016/j.sapharm.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/05/2019] [Accepted: 12/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Increasing the prescribing and dispensing of generic drugs, compared to branded drugs, may increase patient access to affordable drug treatments. Healthcare providers have information needs regarding generic drugs, but available, tailored education materials designed for provider use are lacking. OBJECTIVES To examine healthcare provider opinions and receptivity regarding generic drug educational materials in content, format and design, delivery channel, and level of satisfaction. METHODS A national online survey was conducted in summer 2018 to gather practicing healthcare prescribers' (i.e., physicians, nurse practitioners, physician assistants) and pharmacists' opinions on an educational newsletter developed through a collaboration between the investigators and the U.S. Food and Drug Administration (FDA). Survey data were analyzed using descriptive statistics. Quantitative analyses were performed using SPSS version 24 (IBM, Armonk, NY), while responses to open-ended questions were assessed using qualitative content analysis in Excel. RESULTS A total of 208 surveys were completed. Overall, participants expressed positive opinions about the newsletter's content and format/design. About 69% of prescribers and 60% of pharmacists stated the newsletter gave information that will help them better serve patients. While 15% of surveyed pharmacists stated that they did not have resources to help them get information on generic drug availability and cost, more prescribers (37%) responded similarly. Both prescribers and pharmacists preferred to receive this newsletter via email from the FDA or a professional association. CONCLUSIONS Findings indicate the feasibility of educational outreach programs about generic drugs targeted towards healthcare providers. There is room for improvement in making prescribers and pharmacists aware of resources for learning about generic drug availability and cost. Future studies may test alternate versions of the newsletter that have been tailored to the needs of specific provider specialties or provider practices serving specific patient sub-groups, as well as preferred dissemination frequency.
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Affiliation(s)
- Natalie S Hohmann
- Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Auburn University, 4201 Walker Building, Auburn, AL, 36849, USA.
| | - Kimberly B Garza
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn University, 4306 Walker Building, Auburn, AL, 36849, USA.
| | - Daniel Surry
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn University, 4306 Walker Building, Auburn, AL, 36849, USA.
| | - Richard A Hansen
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn University, 4306 Walker Building, Auburn, AL, 36849, USA.
| | - Ilene Harris
- IMPAQ International LLC, IMPAQ Int., Columbia, MD, 21044, USA.
| | | | - Oluwamurewa Oguntimein
- U.S. Food and Drug Administration (FDA), Office of Generic Drugs (OGD), 10903 New Hampshire Avenue Bldg. 75, Silver Spring, MD, 20993-0002, USA.
| | - Mitchell M Frost
- U.S. Food and Drug Administration (FDA), Office of Generic Drugs (OGD), 10903 New Hampshire Avenue Bldg. 75, Silver Spring, MD, 20993-0002, USA.
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn University, 4306 Walker Building, Auburn, AL, 36849, USA.
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Rainio R, Ahonen R, Timonen J. The content of patient counseling about interchangeable medicines and generic substitution in Finnish community pharmacies - a survey of dispensers. BMC Health Serv Res 2019; 19:956. [PMID: 31829174 PMCID: PMC6907127 DOI: 10.1186/s12913-019-4798-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background Generic substitution aims to increase the use of more affordable generic preparations and restrain the growth of medicine expenditures. Pharmaceutical staff plays an important role in generic substitution by implementing substitution and counseling customers. The aim of this study was to explore how Finnish dispensers inform pharmacy customers about interchangeable medicines and generic substitution and what customers ask dispensers about generic substitution and the reference price system. Methods A questionnaire was sent to a random sample of dispensers (n = 1054) working in community pharmacies in spring 2018. The data was analyzed using frequencies, percentages and the Chi-square test and Fisher’s exact test. The open-ended questions were analyzed first using inductive content analysis and later with the quantitative methods mentioned above. Results The final study material consisted of 498 questionnaires (response rate 51%). The main topics dispensers always informed customers about were the physician’s record in the prescription not to substitute the medicine (69%) and that the prescribed or purchased interchangeable medicine did not belong in the reference price band (59%). Topics mentioned often by dispensers dealt with customer’s chance to choose their medicine from among several alternative products (68%) and the manufacturer of the interchangeable medicines (66%). Differences in appearance (33%) or in composition (28%) of interchangeable products were the most common topics mentioned only when the customer asked about them. Of the respondents 17.6% always and 51.4% often informed the customer about the least expensive interchangeable product at the point of dispensing. Customers’ questions about the generic substitution and reference price system most commonly (82.4%) concerned the similarity of interchangeable medicines. Conclusions Finnish dispensers provide customers with a wide range of information about different subjects when dispensing interchangeable medicines. Patient counseling generally meets the legislative requirements, except for price counseling. In future, information about generic substitution and interchangeable medicines should continuously be provided to customers both at pharmacies and elsewhere, e.g. through educational campaigns.
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Affiliation(s)
- Riikka Rainio
- School of Pharmacy/ Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, Box 1627, FI-70211, Kuopio, PO, Finland.
| | - Riitta Ahonen
- School of Pharmacy/ Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, Box 1627, FI-70211, Kuopio, PO, Finland
| | - Johanna Timonen
- School of Pharmacy/ Social Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, Box 1627, FI-70211, Kuopio, PO, Finland
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Sub-Standard Pharmaceutical Services in Private Healthcare Facilities Serving Low-Income Settlements in Nairobi County, Kenya. PHARMACY 2019; 7:pharmacy7040167. [PMID: 31817394 PMCID: PMC6958324 DOI: 10.3390/pharmacy7040167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/16/2019] [Accepted: 11/25/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Quality pharmaceutical services are an integral part of primary healthcare and a key determinant of patient outcomes. The study focuses on pharmaceutical service delivery among private healthcare facilities serving informal settlements within Nairobi County, Kenya and aims at understanding the drug procurement practices, task-shifting and ethical issues associated with drug brand preference, competition and disposal of expired drugs. Methods: Forty-five private facilities comprising of hospitals, nursing homes, health centres, medical centres, clinics and pharmacies were recruited through purposive sampling. Structured electronic questionnaires were administered to 45 respondents working within the study facilities over an 8-week period. Results: About 50% of personnel carrying out drug procurement belonged to non-pharmaceutical cadres namely; doctors, clinical officers, nurses and pharmacy assistants. Drug brand preferences among healthcare facilities and patients were mainly pegged on perceived quality and price. Unethical business competition practices were recorded, including poor professional demeanour and waiver of consultation fees veiled to undercut colleagues. Government subsidized drugs were sold at 100% profit in fifty percent of the facilities stocking them. In 44% of the facilities, the disposal of expired drugs was not in conformity to existing government regulatory guidelines. Conclusions: There is extensive task-shifting and delegation of pharmaceutical services to non-pharmaceutical cadres and poor observance of ethical guidelines in private facilities. Strict enforcement of regulations is required for optimal practices.
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Maly J, Zimcikova E, Babica J, Kubena AA, Kostriba J, Mala-Ladova K. Representative sample survey on factors determining the Czech physicians’ awareness of generic drugs and substitution. BMC Health Serv Res 2019; 19:777. [PMID: 31666059 PMCID: PMC6822393 DOI: 10.1186/s12913-019-4631-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 10/14/2019] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Generic drugs and generic substitution belong to the tools by which healthcare costs may be reduced. However, low awareness and reluctance among healthcare professionals towards generic drugs may negatively affect the rational use of generic substitution.
Methods
The study aimed to analyze opinions and attitudes towards generic drugs and generic substitution among Czech physicians including their understanding of generic substitution legislative rules and the physicians´ previous experience in this field. Using random allocation, 1551 physicians practicing in the Czech Republic were asked to participate in the sociological representative survey conducted from November to December 2016, through face-to-face structured interviews comprising 19 items. Factor analysis as well as reliability analysis of items focused on legal rules in the context of physicians’ awareness were applied with p-value of < 0.05 as statistically significant.
Results
Of a total of 1237 (79.8%) physicians (43.7% males; mean age 47.5 ± 11.6 years, 46.3% general practitioners) 24.8% considered generic drugs to be less safe, especially those with specialized qualification (p < 0.01). However, only 4.4% of the physicians noticed any drug-related problems, including adverse drug reactions associated with generic substitution. The majority of physicians felt neutrally about performing generic substitution in pharmacies, nor they expressed any opinion on characteristics of generics, even though a better understanding of the legislation and higher need of accordance of substituted drugs were associated with more positive attitudes towards generic substitution (p < 0.05). Physicians showed low knowledge score of legislative rules (mean 3.9 ± 1.6 from maximum 9), nevertheless they overestimated the law, as they considered some rules valid, even if the law does not require them. Cronbach alpha of all legislative rules that regulate generic substitution increased from 0.318 to 0.553 if two optional rules (physician consent and strength equivalence) would be taken into account.
Conclusions
There is no sufficient awareness of generic drugs and generic substitution related issues among Czech physicians, although a deeper knowledge of legislation improves their perception about providing generic substitution.
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Babar ZUD, Ramzan S, El-Dahiyat F, Tachmazidis I, Adebisi A, Hasan SS. The Availability, Pricing, and Affordability of Essential Diabetes Medicines in 17 Low-, Middle-, and High-Income Countries. Front Pharmacol 2019; 10:1375. [PMID: 31824316 PMCID: PMC6880243 DOI: 10.3389/fphar.2019.01375] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/29/2019] [Indexed: 11/13/2022] Open
Abstract
Background: One third of the world population does not have access to essential medicines. Diabetes require a long-term therapy, which incurs significant health care cost and thus impact access and affordability. This study aims to assess the availability, prices, and affordability of four essential medicines used to treat diabetes in private primary care pharmacies in 17 countries. Methods: Data on affordability, availability, and prices of four essential diabetes medicines from 51 primary care pharmacies across 17 countries were obtained using a variation of the World Health Organization/Health Action International (WHO/HAI) methodology. The surveyed countries were Oman, Qatar, Saudi Arabia, United Arab Emirates, China, Jordan, Russia, Armenia, Bangladesh, Egypt, Georgia, India, Pakistan, Sri Lanka, Afghanistan, Nepal, and Tanzania. International reference prices and daily income of the lowest-paid unskilled government workers were used as comparators. The prices were converted into US$ using both foreign exchange rates and purchasing power parity. We compared patterns of affordability and availability and prices of innovator brand (IB) and lowest priced generic (LPG) of diabetes medicines by WHO regional groupings and by country level. Results: Lowest priced generic of metformin 500 mg had the highest total mean availability (≥80%) among all the surveyed medicines. The total mean availability of insulin 100 IU/ml was only 36.21% (IBs and LPGs), where IB was more frequently available than LPG (50% vs. 26%) across 17 surveyed countries. Patients would have to spend more to procure 1-month’s supply of IB of insulin in low-income than patients in high-income countries (no. of day’s wages: 2.37 vs. 0.46, p = 0.038). For the majority of the surveyed countries the median price-ratio was less than 3. The highest PPP-adjusted prices for 30-day treatment with IB of insulin 100 IU/ml and metformin 500 mg were highest in Bangladesh ($80.21) and Tanzania ($4334.17), respectively. Conclusion: Availability of generic form of insulin is poor; IB of insulin was more affordable in high-income countries than low-income countries. Most of the LPGs was reasonably priced and affordable to the lowest-paid unskilled worker.
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Affiliation(s)
- Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
| | - Sara Ramzan
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
| | - Faris El-Dahiyat
- College of Pharmacy, Al Ain University of Science and Technology, Al Ain, United Arab Emirates
| | - Ilias Tachmazidis
- Department of Computer Science, University of Huddersfield, Huddersfield, United Kingdom
| | - Adeola Adebisi
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
| | - Syed Shahzad Hasan
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
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Abdulah DM, Perot KA. Factors Influencing Prescribing Perceived Utility of Drugs: Experiences from Iraqi Kurdistan. Innov Pharm 2019; 10. [PMID: 34007584 PMCID: PMC8051892 DOI: 10.24926/iip.v10i4.2316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Pharmaceutical expenditures have increased dramatically in most developed and developing countries in recent decades. Healthcare system policymakers have expressed concerns about the inappropriate, irrational, or harmful prescribing of drugs. Objectives: The attitudes of physicians towards prescribing generic drugs and predictors of perceived utility of drugs were investigated in the present study. Methods: In this cross-sectional research, 77 physicians at different levels of job hierarchies, working in various public sector shifts, were recruited to participate in a survey of their attitudes toward prescribing generic drugs in Iraqi Kurdistan in 2018. The doctors were located in a general, an emergency, and a pediatric hospital. A self-administered structured questionnaire was designed based on the extended technology acceptance model for product use (TETPU). Results: The doctors agreed that drugs should be prescribed according to their utility for patients (median [M] = 5.0; interquartile range [IQR] = 2.9). Most of the physicians mentioned that they prescribed drugs according to the patients’ needs (75.0%), evaluation of the availability of alternatives (69.0%) and consumer perceptions of a price (69.0%). The analysis showed that (1) the importance of physicians’ perceptions and their recognition of patients’ need achievement (P=.012), (2) the physicians' recognition of the actual use of drugs by consumers (P=.030) and (3) being male (p=.009) were associated with perceptions of drug utility. Conclusions: The study’s results suggest that perceived drug utility in prescription writing is associated with physicians’ perceptions of need achievement and attitudes toward how patients actually use medicines.
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Affiliation(s)
| | - Karwan Ali Perot
- School of Health and Environmental Sciences, Auckland University of Technology, New Zealand and Kurdistan Business School, University of Kurdistan- Hewler, Iraqi Kurdistan
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Langer B, Kunow C. Medication dispensing, additional therapeutic recommendations, and pricing practices for acute diarrhoea by community pharmacies in Germany: a simulated patient study. Pharm Pract (Granada) 2019; 17:1579. [PMID: 31592298 PMCID: PMC6763311 DOI: 10.18549/pharmpract.2019.3.1579] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/08/2019] [Indexed: 02/05/2023] Open
Abstract
Background: In Germany over-the-counter medications (OTC) – which since 2004 are no longer subject to binding prices – can only be purchased in pharmacies. Pharmacy owners and their staff therefore have a special responsibility when dispensing, advising on and setting the prices of medications. Objective: The aim of this study was to assess medication dispensing, additional therapeutic recommendations and pricing practices for acute diarrhoea in adults and to evaluate the role of the patient’s approach (symptom-based versus medication-based request) in determining the outcome of these aspects. Methods: A cross-sectional study was conducted from 1 May to 31 July 2017 in all 21 community pharmacies in a medium-sized German city. Symptom-based and medication-based scenarios related to self-medication of acute diarrhoea were developed and used by five simulated patients (SPs) in all of the pharmacies (a total of 84 visits). Differentiating between the different test scenarios in terms of the commercial and active ingredient names and also the prices of the medications dispensed, the SPs recorded on collection forms whether the scenario involved generic products or original preparations as well as whether recommendations were made during the test purchases regarding an additional intake of fluids. Results: In each of the 84 test purchases one preparation was dispensed. However, a preparation for oral rehydration was not sold in a single test purchase. On the other hand, in 74/84 (88%) of test purchases, medications with the active ingredient loperamide were dispensed. In only 35/84 (42%) of test purchases, the patient was also recommended to ensure an ‘adequate intake of fluids’ in addition to being dispensed a medication. In symptom-based scenarios significantly more expensive medications were dispensed compared to the medication-based scenarios (Wilcoxon signed rank test: z = -4.784, p < 0.001, r = 0.738). Also within the different scenarios there were enormous price differences identified – for example, in the medication-based scenarios, even for comparable loperamide generics the cheapest preparation cost EUR 1.99 and the most expensive preparation cost EUR 4.53. Conclusions: Oral rehydration was not dispensed and only occasionally was an adequate intake of fluids recommended. There were also enormous price differences both between and within the scenarios investigated.
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Affiliation(s)
- Bernhard Langer
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg. Neubrandenburg (Germany).
| | - Christian Kunow
- Research Associate. Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg. Neubrandenburg (Germany).
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Lin YS, Lin MT, Cheng SH. Drug price, dosage and safety: Real-world evidence of oral hypoglycemic agents. Health Policy 2019; 123:1221-1229. [PMID: 31466805 DOI: 10.1016/j.healthpol.2019.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Drug price reduction is one of the major policies to restrain pharmaceutical expenses worldwide. This study explores whether there is a relationship between drug price and clinical quality using real-world data. METHODS Patients with newly-diagnosed type 2 diabetes receiving metformin or sulfonylureas during 2001 and 2010 were identified using the claim database of the Taiwan universal health insurance system. Propensity score matching was performed to obtain comparable subjects for analysis. Pharmaceutical products were categorized as brand-name agents (BD), highpriced generics (HP) or low-priced generics (LP). Indicators of clinical quality were defined as the dosage of cumulative oral hypoglycemic agents (OHA), exposure to other pharmacological classes of OHA, hospitalization or urgent visit for hypoglycemia or hyperglycemia, insulin utilization and diagnosis of diabetic complications within 1 year after diagnosis. RESULTS A total of 40,152 study subjects were identified. A generalized linear mix model showed that HP and BD users received similar OHA dosages with comparable clinical outcomes. By contrast, LP users had similar outcomes to BD users but received a 39% greater OHA dosage. A marginally higher risk of poor glycemic control in LP users was also observed. CONCLUSIONS Drug price is related to indicators of clinical quality. Clinicians and health authorities should monitor the utilization, effectiveness and clinical safety indicators of generic drugs, especially those with remarkably low prices.
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Affiliation(s)
- Yu-Shiuan Lin
- Department of Pharmacy, Taipei Veterans General Hospital, Taipei City, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Min-Ting Lin
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Shou-Hsia Cheng
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, Taiwan; Population Health Research Center, National Taiwan University, Taipei City, Taiwan.
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Brown JD, Henriksen C, Vozmediano V, Schmidt S. Real-World Data Approaches for Early Detection of Potential Safety and Effectiveness Signals for Generic Substitution: A Metoprolol Extended-Release Case Study. J Clin Pharmacol 2019; 59:1275-1284. [PMID: 31087552 DOI: 10.1002/jcph.1436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/11/2019] [Indexed: 01/08/2023]
Abstract
Real-world spontaneous adverse event reports and administrative health care data were utilized as one part of a multipronged approach to verify surveillance signals related to generic drug formulations. This study used metoprolol succinate extended release as a historic case example from which to develop an analytic framework. The US Food and Drug Administration Adverse Event Reporting System was utilized for disproportionality analyses and to identify outcomes of interest. Claims data were analyzed for generic uptake, proportion of prescriptions with "dispense as written" orders, time to discontinuation or switching, and relative rates of clinical events. Adverse Event Reporting System data showed that the Medical Dictionary for Regulatory Activities terms for product quality were higher for generic metoprolol cases and that a number of clinical events were increased that could be side effects of high or low variability in drug levels. Compared to amlodipine-benazepril, which also had a first-approved generic at the same time, market share data showed that metoprolol succinate had lower utilization and more prescriptions written as dispense as written. Switching and discontinuation were generally higher for metoprolol users compared to amlodipine-benazepril users. Finally, clinical event rates were generally higher for generic versus brand metoprolol but lower for the same comparison for amlodipine-benazepril users. In the claims-based analyses, the 90-day period immediately after generic entry provided stronger signal capture than using the entire study period. This analytic framework can be implemented to actively monitor new generic formulations for potential bioequivalence failures. Signals from these analyses require confirmation (eg, via pharmacometric analyses) to be informative for regulatory action.
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Affiliation(s)
- Joshua D Brown
- Department of Pharmaceutical Outcomes & Policy, Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Center for Drug Evaluation & Safety, University of Florida, Gainesville, FL, USA
| | - Carl Henriksen
- Department of Pharmaceutical Outcomes & Policy, Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL, USA.,Center for Drug Evaluation & Safety, University of Florida, Gainesville, FL, USA
| | - Valvanera Vozmediano
- Center for Pharmacometrics and Systems Pharmacology, Department of Pharmaceutics, College of Pharmacy, University of Florida, Orlando, FL, USA
| | - Stephan Schmidt
- Center for Pharmacometrics and Systems Pharmacology, Department of Pharmaceutics, College of Pharmacy, University of Florida, Orlando, FL, USA
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Mansilla C, Cárdenas J, Kaplan WA, Wirtz VJ, Kuhn-Barrientos L, Ortíz de Zárate M, Tobar T, Herrera CA. Evaluation of the effects of a generic substitution policy implemented in Chile. BMJ Glob Health 2019; 2:e000922. [PMID: 30899555 PMCID: PMC6407566 DOI: 10.1136/bmjgh-2018-000922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 11/22/2018] [Accepted: 11/23/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Chile implemented a generic substitution policy in 2014 to improve access to medicines. This study aims to measure if the generic substitution policy had an effect on the sales volume and prices of referent and the branded generic products with demonstrated bioequivalence (BEQ) in the private pharmaceutical market. Methods The volume and total private sales of medicines sold at private sector retail outlets between November 2011 and October 2016 were considered in the analysis. We calculated the total number of daily defined doses (DDD) by adding up the number of DDDs of different presentations with the active pharmaceutical ingredient (API). We determined the ratio of the median prices of all BEQ per DDD presentations compared with the median price of the corresponding referent presentations per DDD in 2011 and 2016. Sixteen APIs representing 231 different conventional-release presentations were included in the analysis. Results Overall, the volume of sales of the referent products decreased over time after the intervention. However, this reduction was not mirrored by an increase in the corresponding branded generic BEQ volumes overall. In all cases, the median price per DDD of the referent was higher than its BEQ counterpart in 2011 and 2016. Conclusion Since referent products are more costly than branded BEQ generic products, reducing their consumption—and increasing the BEQ availability—should improve access to medicines in Chile. However, this must be accompanied by promotion of BEQ products to ensure savings for consumers in the long term. Future research should focus on identifying facilitating and inhibiting factors of generic substitution.
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Affiliation(s)
| | | | - Warren A Kaplan
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | | | - Tatiana Tobar
- Ministerio de Salud, Gobierno de Chile, Santiago, Chile
| | - Cristian A Herrera
- Health Division, OECD, Paris, Île-de-France, France.,Department of Public Health, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Blier P, Margolese HC, Wilson EA, Boucher M. Switching medication products during the treatment of psychiatric illness. Int J Psychiatry Clin Pract 2019; 23:2-13. [PMID: 30732488 DOI: 10.1080/13651501.2018.1508724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The common practice of switching between branded (reference) medications and their corresponding generic products, between generic products, or even from a generic product to a branded medication during the treatment of central nervous system (CNS) disorders may compromise efficacy and/or tolerability. METHODS We assessed the published literature from March 1, 2010 through June 30, 2017 via PubMed using the MeSH term 'generics, drugs' alone and in combination with class-specific terms (e.g., 'anticonvulsants', 'mood stabilisers'), for studies detailing outcomes following product switches. RESULTS Although some studies comparing the initiation of reference versus generic drugs suggest equivalence between products, several studies detailing a switch between reference and generic products describe reductions in efficacy, reduced medication adherence and persistence, and increased overall health care resource utilization and costs associated with generic substitution. CONCLUSION When product switches are considered, they should only proceed with the full knowledge of both patient and provider.
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Affiliation(s)
- Pierre Blier
- a University of Ottawa Institute of Mental Health Research , Ottawa , ON , Canada
| | | | | | - Matthieu Boucher
- d Department of Pharmacology & Therapeutics , McGill University, McIntyre Medical Science Building , Montréal , QC , Canada.,e Medical Affairs, Pfizer Canada Inc , Kirkland , QC , Canada
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Souliotis K, Golna C, Kani C, Markantonis S. Exploring knowledge and perceptions on generic drugs of final year pharmacy school students in Greece. Expert Rev Pharmacoecon Outcomes Res 2019; 19:569-574. [PMID: 30658041 DOI: 10.1080/14737167.2019.1571412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: The economic crisis in Greece has triggered an extensive public debate about the use of generic drugs (generics). Despite their cost-saving potential, generic market penetration remains very low. This raises questions on awareness of, perception on and preference for generics by health-care professionals and patients. This is a descriptive study on the level of knowledge and attitudes towards generics of final year pharmacy school students in Greece. Methods: An electronic questionnaire was distributed to 173 senior pharmacy school students in three Universities in Greece. Responses were submitted electronically. Results: The majority of students knew that generics contain the same active ingredient as the originator products and are cheaper. Students were somehow concerned with safety and efficacy of generics. The majority of students agreed that pharmacists should probably recommend the use of generics, and indicated that prescribing and dispensing practices would largely depend on the profit margin. Despite more than half of the students expressing a positive attitude towards generics, they were inadequately educated on their features. Conclusion: It is critical to improve knowledge of and preference for generics amongst health-care professionals from early on if to build the trust required to increase generic market penetration and achieve measurable savings in pharmaceutical expenditure.
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Affiliation(s)
- Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese , Corinth , Greece.,Health Policy Institute , Athens , Greece
| | | | - Chara Kani
- Faculty of Social and Political Sciences, University of Peloponnese , Corinth , Greece
| | - Sophia Markantonis
- Department of Pharmacy, National and Kapodistrian University of Athens , Athens , Greece
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Mondelo-García C, Mendoza E, Movilla-Fernández MJ, Coronado C. Perceptions of pharmacists and physicians on generic substitution in a financial crisis context in Northwestern Spain: A qualitative study. Health Policy 2018; 122:1316-1325. [PMID: 30201184 DOI: 10.1016/j.healthpol.2018.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 08/14/2018] [Accepted: 08/24/2018] [Indexed: 11/28/2022]
Abstract
In Spain, the use of generics has considerably evolved in a short period of time through different anti-crisis legislation changes. Before the financial crisis the proposal of generics was an option for patients. Nowadays its use is actively enforced by Health authorities. OBJECTIVE To explore the perceptions of pharmacists and physicians regarding the generic substitution driven by new Spanish drugs policies as well as their adaptive strategies intended to lessen the impact of changes to their patients' treatment. METHODS Pharmacists (16) and physicians (13) from Ferrol and A Coruña participated in a qualitative study using semi-structured in-depth interviews. RESULTS Qualitative analysis allowed identification of nine key components in the substitution process: Enabling factors: 'Adequate information to patients', 'Acute treatments', 'Bioappearance', 'Prescription by Estate Official Denomination followed by laboratory name', 'Personalized dosage systems'. Obstructing factors: 'Generics/Authorities distrust', 'Lack of time', 'Patient characteristics', 'Pharmacy financial management'. CONCLUSIONS Pharmacists and physicians in our economic crisis context perceive different barriers resulting in difficulties in the generic substitution process. They have implemented strategies to capitalize on the enablers and overcome the additional budget-cut barriers imposed by the Administration that had prevented them from maintaining their patient's treatment preferences. Spanish health authorities could improve current legislation either by reducing the number of new laboratories of authorized generic manufacturers or by extending the pharmacist capability for equivalent drugs substitution.
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Affiliation(s)
- Cristina Mondelo-García
- Grupo de investigación GRINCAR, Departamento de Ciencias da Saúde, Facultade de Enfermaría e Podoloxía, Universidade da Coruña, 15471 Ferrol, Spain
| | - Elvia Mendoza
- Grupo de investigación GRINCAR, Departamento de Ciencias da Saúde, Facultade de Enfermaría e Podoloxía, Universidade da Coruña, 15471 Ferrol, Spain
| | - María-Jesús Movilla-Fernández
- Grupo de investigación GRINCAR, Departamento de Ciencias da Saúde, Facultade de Enfermaría e Podoloxía, Universidade da Coruña, 15471 Ferrol, Spain
| | - Carmen Coronado
- Grupo de investigación GRINCAR, Departamento de Ciencias da Saúde, Facultade de Enfermaría e Podoloxía, Universidade da Coruña, 15471 Ferrol, Spain.
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The adoption of generic drugs by a hospital: effects on drug dispensation among community pharmacies. J Pharm Health Care Sci 2018; 4:6. [PMID: 29564146 PMCID: PMC5853161 DOI: 10.1186/s40780-018-0102-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background The objective of the current study is to elucidate the effect that the adoption of generic drugs by a large hospital has on the dispensation of generic drugs by community pharmacies. We evaluated the percentage of generic drugs dispensed by pharmacies and the cost of drugs dispensed before and after the adoption of generic drugs by a large hospital. Methods Participants comprised patients who were admitted to Gifu Municipal Hospital prior to its adoption of generic drugs (November 1, 2013 to November 14, 2013) and after its adoption (November 1, 2014 to November 14, 2014) and who utilized generic drugs dispensed by pharmacies. Results Results indicated that the pre-adoption dispensation rate of generic drugs by pharmacies was 48.3% (477/926 drugs), while the post-adoption rate was 57.7% (604/1046 drugs), indicating an increase of 9.4 points (P < 0.001). Furthermore, an investigation into the price paid for generic drugs as a percentage of the total price paid for all drugs indicated the following: the pre-adoption percentage was 23.5% (9756/41,461 yen), and the post-adoption percentage was 34.1% (19,221/56,438 yen), indicating an increase of 10.6 points (P < 0.001). Conclusions The results of this study revealed that the adoption of generic drugs by a hospital may promote the use of generic drugs by pharmacies and lead to reduced medical costs as well.
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Tachi T, Saito K, Esaki H, Kanematsu Y, Yoshida A, Sugita I, Noguchi Y, Makino T, Umeda M, Yasuda M, Mizui T, Goto C, Teramachi H. Medical and economic factors influencing generic drug use in the Japanese public health system: Influencing factors in different populations. Int J Health Plann Manage 2018; 33:489-501. [DOI: 10.1002/hpm.2489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/06/2017] [Accepted: 12/19/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Tomoya Tachi
- Laboratory of Clinical PharmacyGifu Pharmaceutical University Gifu Japan
- Department of PharmacyGifu Municipal Hospital Gifu Japan
| | - Kosuke Saito
- Laboratory of Clinical PharmacyGifu Pharmaceutical University Gifu Japan
| | - Hiroki Esaki
- Laboratory of Clinical PharmacyGifu Pharmaceutical University Gifu Japan
| | - Yuta Kanematsu
- Laboratory of Clinical PharmacyGifu Pharmaceutical University Gifu Japan
| | - Aki Yoshida
- Laboratory of Clinical PharmacyGifu Pharmaceutical University Gifu Japan
| | - Ikuto Sugita
- Laboratory of Clinical PharmacyGifu Pharmaceutical University Gifu Japan
| | - Yoshihiro Noguchi
- Laboratory of Clinical PharmacyGifu Pharmaceutical University Gifu Japan
| | - Teppei Makino
- Department of PharmacyGifu Municipal Hospital Gifu Japan
| | - Michi Umeda
- Department of PharmacyGifu Municipal Hospital Gifu Japan
| | | | - Takashi Mizui
- Department of PharmacyGifu Municipal Hospital Gifu Japan
| | - Chitoshi Goto
- Department of PharmacyGifu Municipal Hospital Gifu Japan
| | - Hitomi Teramachi
- Laboratory of Clinical PharmacyGifu Pharmaceutical University Gifu Japan
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Alonso TR, Gagol A, Scherer M, Matji A, Torrado-Santiago S, Serrano DR, Garcia-Arieta A, Torrado JJ. A multivariate investigation into the relationship between pharmaceutical characteristics and patient preferences of bioequivalent ibuprofen tablets. Patient Prefer Adherence 2018; 12:1927-1935. [PMID: 30288033 PMCID: PMC6163020 DOI: 10.2147/ppa.s174479] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In Spain the price of all ibuprofen 600 mg tablet generic products is the same due to reimbursement existing rules so for the patient there is not any economic incentive to choose a particular one. Bearing in mind that the quality of generic products should be similar, it could be questioned if differences in patient preferences evaluated as sales could be related to differences on their pharmaceutical properties. The aims of this work were to study the variability on the pharmaceutical characteristics of marketed bioequivalent tablet formulations and its impact on patient preferences. METHODS Thirty-six batches corresponding to fourteen different generic products were chosen among the best-selling products of the Spanish market in the years 2011 and 2015 and were compared to the reference product. The effect on patient preferences of six variables was studied through a multivariate analysis. The first two variables were marketing characteristics: 1) years in the market and 2) the number of other generic products marketed by the same manufacturer, which could be related to the size and service provided by the manufacturer. The other four variables studied were pharmaceutical tablet properties: 3) mean weight, 4) hardness, 5) disintegration, and 6) dissolution. A multiple linear regression analysis was performed to identify the effect on sales of the six variables studied. RESULTS The disintegration time was the most significant (P=0.018) factor affecting the sales of Ibuprofen tablets which may be related to the onset of action. CONCLUSION The faster the tablet disintegration, the higher its sales. Two possible explanations are suggested: 1) the most specialized ibuprofen tablet manufacturer considers fast disintegration as a key parameter and/or 2) habitual consumers of ibuprofen can detect small differences on the onset of action among different marketed formulations. In this work, all marketed ibuprofen tablets comply with the pharmacopoeia specifications.
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Affiliation(s)
- Tatiana R Alonso
- Pharmaceutics and Food Technology, School of Pharmacy, Complutense University, Madrid, Spain,
| | - Adrianna Gagol
- Pharmaceutics and Food Technology, School of Pharmacy, Complutense University, Madrid, Spain,
| | - Maximilian Scherer
- Pharmaceutics and Food Technology, School of Pharmacy, Complutense University, Madrid, Spain,
| | - Antonio Matji
- Pharmaceutics and Food Technology, School of Pharmacy, Complutense University, Madrid, Spain,
| | | | - Dolores R Serrano
- Pharmaceutics and Food Technology, School of Pharmacy, Complutense University, Madrid, Spain,
| | - Alfredo Garcia-Arieta
- Service on Pharmacokinetics and Generics, Department of Human Use Medicines, Division of Pharmacology and Clinical Evaluation, Spanish Agency for Medicines and Health Care Products, Madrid, Spain
| | - Juan J Torrado
- Pharmaceutics and Food Technology, School of Pharmacy, Complutense University, Madrid, Spain,
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Hammami MM, De Padua SJS, Hussein R, Al Gaai E, Khodr NA, Al-Swayeh R, Alvi SN, Binhashim N. Generic-reference and generic-generic bioequivalence of forty-two, randomly-selected, on-market generic products of fourteen immediate-release oral drugs. BMC Pharmacol Toxicol 2017; 18:78. [PMID: 29216899 PMCID: PMC5721559 DOI: 10.1186/s40360-017-0182-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/22/2017] [Indexed: 12/21/2022] Open
Abstract
Background The extents of generic-reference and generic-generic average bioequivalence and intra-subject variation of on-market drug products have not been prospectively studied on a large scale. Methods We assessed bioequivalence of 42 generic products of 14 immediate-release oral drugs with the highest number of generic products on the Saudi market. We conducted 14 four-sequence, randomized, crossover studies on the reference and three randomly-selected generic products of amlodipine, amoxicillin, atenolol, cephalexin, ciprofloxacin, clarithromycin, diclofenac, ibuprofen, fluconazole, metformin, metronidazole, paracetamol, omeprazole, and ranitidine. Geometric mean ratios of maximum concentration (Cmax) and area-under-the-concentration-time-curve, to last measured concentration (AUCT), extrapolated to infinity (AUCI), or truncated to Cmax time of reference product (AUCReftmax) were calculated using non-compartmental method and their 90% confidence intervals (CI) were compared to the 80.00%–125.00% bioequivalence range. Percentages of individual ratios falling outside the ±25% range were also determined. Results Mean (SD) age and body-mass-index of 700 healthy volunteers (28–80/study) were 32.2 (6.2) years and 24.4 (3.2) kg/m2, respectively. In 42 generic-reference comparisons, 100% of AUCT and AUCI CIs showed bioequivalence, 9.5% of Cmax CIs barely failed to show bioequivalence, and 66.7% of AUCReftmax CIs failed to show bioequivalence/showed bioinequivalence. Adjusting for 6 comparisons, 2.4% of AUCT and AUCI CIs and 21.4% of Cmax CIs failed to show bioequivalence. In 42 generic-generic comparisons, 2.4% of AUCT, AUCI, and Cmax CIs failed to show bioequivalence, and 66.7% of AUCReftmax CIs failed to show bioequivalence/showed bioinequivalence. Adjusting for 6 comparisons, 2.4% of AUCT and AUCI CIs and 14.3% of Cmax CIs failed to show bioequivalence. Average geometric mean ratio deviation from 100% was ≤3.2 and ≤5.4 percentage points for AUCI and Cmax, respectively, in both generic-reference and generic-generic comparisons. Individual generic/reference and generic/generic ratios, respectively, were within the ±25% range in >75% of individuals in 79% and 71% of the 14 drugs for AUCT and 36% and 29% for Cmax. Conclusions On-market generic drug products continue to be reference-bioequivalent and are bioequivalent to each other based on AUCT, AUCI, and Cmax but not AUCReftmax. Average deviation of geometric mean ratios and intra-subject variations are similar between reference-generic and generic-generic comparisons. Trial registration ClinicalTrials.gov identifier: NCT01344070 (registered April 3, 2011). Electronic supplementary material The online version of this article (doi:10.1186/s40360-017-0182-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Muhammad M Hammami
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Center, P O Box # 3354, MBC 03, Riyadh, 11211, Saudi Arabia. .,Alfaisal University College of Medicine, Riyadh, Saudi Arabia.
| | - Sophia J S De Padua
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Center, P O Box # 3354, MBC 03, Riyadh, 11211, Saudi Arabia
| | - Rajaa Hussein
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Center, P O Box # 3354, MBC 03, Riyadh, 11211, Saudi Arabia
| | - Eman Al Gaai
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Center, P O Box # 3354, MBC 03, Riyadh, 11211, Saudi Arabia
| | - Nesrine A Khodr
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Center, P O Box # 3354, MBC 03, Riyadh, 11211, Saudi Arabia
| | - Reem Al-Swayeh
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Center, P O Box # 3354, MBC 03, Riyadh, 11211, Saudi Arabia
| | - Syed N Alvi
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Center, P O Box # 3354, MBC 03, Riyadh, 11211, Saudi Arabia
| | - Nada Binhashim
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Center, P O Box # 3354, MBC 03, Riyadh, 11211, Saudi Arabia
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Riner B, Bussy A, Hélène-Pelage J, Moueza N, Lamy S, Carrère P. "No generics, Doctor!" The perspective of general practitioners in two French regions. BMC Health Serv Res 2017; 17:707. [PMID: 29121918 PMCID: PMC5680768 DOI: 10.1186/s12913-017-2682-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 11/03/2017] [Indexed: 12/13/2022] Open
Abstract
Background Generic medicines are essential to controlling health expenditures. Their market share is still small in France. The discourse and practices of prescribers may play a major role in their use. The purpose of this study was to explore the knowledge, attitudes and practices of general practitioners (GPs) toward generic medicines in two French regions with the lowest penetration rate of these products. Methods An observational study was carried out from October 2015 to February 2016 in Guadeloupe and Martinique. The first qualitative phase involved a diversified sample of 14 GPs who underwent semi-structured interviews. The second phase involved a random sample of 316 GPs (response rate = 74%) who were administered a structured questionnaire developed from the results of the first phase. Results Seventy-eight percent of the participants defined a generic drug as a drug containing an active substance identical to a brand-name drug, but only 11% considered generic drugs to be equivalent to brand-name drugs, and the same proportion believed that the generic drugs were of doubtful quality. The primary recognized advantage of generic medicines was their lower cost (82%). The main drawbacks cited were the variability of their presentation (44%), the confusion that they caused for some patients (47%), frequent allegations of adverse side effects (37%) and a lack of efficacy (24%), and frequent refusal by patients (26%). Seventy-four percent of the participants stated that they adapted their prescribing practices to the situation, and of this group, 47% prescribed the originator product simply on demand. Conclusion Most surveyed GPs were not hostile towards generic medicines. They were caught between the requirements of health insurance regimes and the opposition of numerous users and suggested that the patient information provided by health authorities should be improved and that drug composition and packaging should be made uniform.
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Affiliation(s)
- Béatrice Riner
- Department of General Practice, University of the French West Indies, Pointe-à-Pitre, France
| | - Adèle Bussy
- Department of General Practice, University of the French West Indies, Pointe-à-Pitre, France
| | - Jeannie Hélène-Pelage
- Department of General Practice, University of the French West Indies, Pointe-à-Pitre, France
| | - Nycrees Moueza
- Department of General Practice, University of the French West Indies, Pointe-à-Pitre, France
| | - Sébastien Lamy
- Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France.,Laboratory of Epidemiology and Analysis in Public Health, UMR1027 INSERM, University of Toulouse III Paul Sabatier, Toulouse, France
| | - Philippe Carrère
- Department of General Practice, University of the French West Indies, Pointe-à-Pitre, France. .,Laboratory of Epidemiology and Analysis in Public Health, UMR1027 INSERM, University of Toulouse III Paul Sabatier, Toulouse, France. .,Département de Médecine Générale, Faculté de Médecine Hyacinthe Bastaraud, Campus Universitaire de Fouillole, Université des Antilles, 97157 Pointe-à-Pitre Cedex, Guadeloupe, BP 250, France.
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Sanyal SN, Datta SK, Banerjee AK. Factors influencing prescribing decisions among physicians: an empirical study on generic drugs. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2017. [DOI: 10.1108/ijphm-06-2016-0031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to examine the physicians’ attitude toward branded generic drugs in prescribing those drugs in some selective medical conditions and to identify the factors that influence physicians’ behavior toward prescribing branded generic drugs in the said selective medical conditions.
Design/methodology/approach
The study was carried out across six major cities in eastern India with 301 physicians. The current study introduced some significant elements into the modified technology acceptance model (TAM) with title the extended tam for product usage (TETPU) to analyze the prescribing factors that influence physicians in five common yet serious medical conditions in India. Out of nine factors considered here, seven were selected from the previous literature studies of different product segments and two were proposed by the authors. Demographic factor was proposed as the confounding variable.
Findings
The results indicated that apart from the factors “perceived no need” and “physicians’ perception and need achievement” rest of the factors showed satisfactory to excellent results.
Practical implications
The current study findings may enable the pharmaceutical managers to revise or modify their current marketing communication and other brand-building strategies so as to achieve a superior performance that offers them a competitive advantage.
Originality/value
The paper fulfils a need for advancing the knowledge on the physician’s prescription influencing factors by introducing the newer aspects of the concept and offers a theoretical framework for the academia and practical framework for the managers who desire to implement the strategies to achieve competitive advantage.
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WOUTERS OLIVIERJ, KANAVOS PANOSG, McKEE MARTIN. Comparing Generic Drug Markets in Europe and the United States: Prices, Volumes, and Spending. Milbank Q 2017; 95:554-601. [PMID: 28895227 PMCID: PMC5594322 DOI: 10.1111/1468-0009.12279] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Policy Points: Our study indicates that there are opportunities for cost savings in generic drug markets in Europe and the United States. Regulators should make it easier for generic drugs to reach the market. Regulators and payers should apply measures to stimulate price competition among generic drugmakers and to increase generic drug use. To meaningfully evaluate policy options, it is important to analyze historical context and understand why similar initiatives failed previously. CONTEXT Rising drug prices are putting pressure on health care budgets. Policymakers are assessing how they can save money through generic drugs. METHODS We compared generic drug prices and market shares in 13 European countries, using data from 2013, to assess the amount of variation that exists between countries. To place these results in context, we reviewed evidence from recent studies on the prices and use of generics in Europe and the United States. We also surveyed peer-reviewed studies, gray literature, and books published since 2000 to (1) outline existing generic drug policies in European countries and the United States; (2) identify ways to increase generic drug use and to promote price competition among generic drug companies; and (3) explore barriers to implementing reform of generic drug policies, using a historical example from the United States as a case study. FINDINGS The prices and market shares of generics vary widely across Europe. For example, prices charged by manufacturers in Switzerland are, on average, more than 2.5 times those in Germany and more than 6 times those in the United Kingdom, based on the results of a commonly used price index. The proportion of prescriptions filled with generics ranges from 17% in Switzerland to 83% in the United Kingdom. By comparison, the United States has historically had low generic drug prices and high rates of generic drug use (84% in 2013), but has in recent years experienced sharp price increases for some off-patent products. There are policy solutions to address issues in Europe and the United States, such as streamlining the generic drug approval process and requiring generic prescribing and substitution where such policies are not yet in place. The history of substitution laws in the United States provides insights into the economic, political, and cultural issues influencing the adoption of generic drug policies. CONCLUSIONS Governments should apply coherent supply- and demand-side policies in generic drug markets. An immediate priority is to convince more physicians, pharmacists, and patients that generic drugs are bioequivalent to branded products. Special-interest groups continue to obstruct reform in Europe and the United States.
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Ryu M, Kim J. Perception and attitude of Korean physicians towards generic drugs. BMC Health Serv Res 2017; 17:610. [PMID: 28851368 PMCID: PMC5575936 DOI: 10.1186/s12913-017-2555-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 08/17/2017] [Indexed: 12/03/2022] Open
Abstract
Background In 2012, a new pharmaceutical policy was introduced in Korea. According to the new policy, off-patent brand-name drugs (original drugs) and generic drugs must be priced the same. Methods This study aims to investigate the perception and attitude of Korean physicians towards generic drugs before and after the policy reform. Surveys were conducted with registered doctors at the Health Insurance Review Agency (HIRA) twice, in 2011 and 2013, by means of email and HIRA online survey systems. Results In the 2011 survey, 82% knew about the bioequivalent (BE) guideline, whereas only 25.7% trusted BE testing results. More than half preferred original drugs to generic drugs because of clinical experience and generic drugs confidence limits. 64.2% pointed out that the Korean generic drugs prices are more expensive than in other counties. In the 2013 survey, 73% preferred original drugs to generic drugs because of believed difference in drug effectiveness. After the pricing policy reform, 35.5% stated that they didn’t change their prescribing pattern, whereas 29.7% stated that they began prescribing generic drugs. Conclusions The Korean government has revised and strengthen the guideline on BE test to improve the quality and confidence of generic drugs. Although generic drugs prescription was increased slightly more than the 2011 survey, 2013 survey showed that around 70% of respondents still preferred original drugs.
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Affiliation(s)
- Mikyung Ryu
- Pharmaceutical Benefits, Management division, Health Insurance Review & Assessment Service, 304 Hyoryeong-ro, Seocho-gu, Seoul, 06720, South Korea
| | - Juyoung Kim
- Pharmaceutical Benefits, Management division, Health Insurance Review & Assessment Service, 304 Hyoryeong-ro, Seocho-gu, Seoul, 06720, South Korea.
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van der Gronde T, Uyl-de Groot CA, Pieters T. Addressing the challenge of high-priced prescription drugs in the era of precision medicine: A systematic review of drug life cycles, therapeutic drug markets and regulatory frameworks. PLoS One 2017; 12:e0182613. [PMID: 28813502 PMCID: PMC5559086 DOI: 10.1371/journal.pone.0182613] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
CONTEXT Recent public outcry has highlighted the rising cost of prescription drugs worldwide, which in several disease areas outpaces other health care expenditures and results in a suboptimal global availability of essential medicines. METHOD A systematic review of Pubmed, the Financial Times, the New York Times, the Wall Street Journal and the Guardian was performed to identify articles related to the pricing of medicines. FINDINGS Changes in drug life cycles have dramatically affected patent medicine markets, which have long been considered a self-evident and self-sustainable source of income for highly profitable drug companies. Market failure in combination with high merger and acquisition activity in the sector have allowed price increases for even off-patent drugs. With market interventions and the introduction of QALY measures in health care, governments have tried to influence drug prices, but often encounter unintended consequences. Patent reform legislation, reference pricing, outcome-based pricing and incentivizing physicians and pharmacists to prescribe low-cost drugs are among the most promising short-term policy options. Due to the lack of systematic research on the effectiveness of policy measures, an increasing number of ad hoc decisions have been made with counterproductive effects on the availability of essential drugs. Future challenges demand new policies, for which recommendations are offered. CONCLUSION A fertile ground for high-priced drugs has been created by changes in drug life-cycle dynamics, the unintended effects of patent legislation, government policy measures and orphan drug programs. There is an urgent need for regulatory reform to curtail prices and safeguard equitable access to innovative medicines.
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Affiliation(s)
- Toon van der Gronde
- Department of Pharmaceutical Sciences, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Carin A. Uyl-de Groot
- Institute for Medical Technology Assessment, Department of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Toine Pieters
- Department of Pharmaceutical Sciences, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
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Flood D, Mathieu I, Chary A, García P, Rohloff P. Perceptions and utilization of generic medicines in Guatemala: a mixed-methods study with physicians and pharmacy staff. BMC Health Serv Res 2017; 17:27. [PMID: 28086866 PMCID: PMC5234139 DOI: 10.1186/s12913-017-1991-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Access to low-cost essential generic medicines is a critical health policy goal in low-and-middle income countries (LMICs). Guatemala is an LMIC where there is both limited availability and affordability of these medications. However, attitudes of physicians and pharmacy staff regarding low-cost generics, especially generics for non-communicable diseases (NCDs), have not been fully explored in Guatemala. METHODS Semi-structured interviews with 30 pharmacy staff and 12 physicians in several highland towns in Guatemala were conducted. Interview questions related to perceptions of low-cost generic medicines, prescription and dispensing practices of generics in the treatment of two NCDs, diabetes and hypertension, and opinions about the roles of pharmacy staff and physicians in selecting medicines for patients. Pharmacy staff were recruited from a random sample of pharmacies and physicians were recruited from a convenience sample. Interview data were analyzed using a thematic approach for qualitative data as well as basic quantitative statistics. RESULTS Pharmacy staff and physicians expressed doubt as to the safety and efficacy of low-cost generic medicines in Guatemala. The low cost of generic medicines was often perceived as proof of their inferior quality. In the case of diabetes and hypertension, the decision to utilize a generic medicine was based on multiple factors including the patient's financial situation, consumer preference, and, to a large extent, physician recommendations. CONCLUSIONS Interventions to improve generic medication utilization in Guatemala must address the negative perceptions of physicians and pharmacy staff toward low-cost generics. Strengthening state capacity and transparency in the regulation and monitoring of the drug supply is a key goal of access-to-medicines advocacy in Guatemala.
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Affiliation(s)
- David Flood
- Wuqu' Kawoq
- Maya Health Alliance, 2 Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala.
| | - Irène Mathieu
- Wuqu' Kawoq
- Maya Health Alliance, 2 Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala
| | - Anita Chary
- Wuqu' Kawoq
- Maya Health Alliance, 2 Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala
| | - Pablo García
- Wuqu' Kawoq
- Maya Health Alliance, 2 Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala
| | - Peter Rohloff
- Wuqu' Kawoq
- Maya Health Alliance, 2 Calle 5-43 Zona 1, Santiago Sacatepéquez, Guatemala
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Lucas-Dominguez R, Vidal-Infer A, Alonso-Arroyo A, Navarro C, Valderrama-Zurián JC, Aleixandre-Benavent R. Patterns and Trends in Scientific Research on Generic Drugs. Clin Ther 2016; 38:2684-2689.e1. [PMID: 27842713 DOI: 10.1016/j.clinthera.2016.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study to investigate the evolution and current status of peer-reviewed publications concerning generic drugs during the past few decades. METHODS Scientific articles about generic drugs published until 2012 were retrieved through the PubMed/MEDLINE database, and a content analysis was performed. FINDINGS Our study revealed an increasing number of publications on generics since 1984. Statins, antiretroviral therapies, and antiepileptics, followed by immunosuppressants and antithrombotic agents, were the most common therapeutic drug categories. IMPLICATIONS Almost 60% of the generics detailed in studies indexed in MEDLINE were acting on the cardiovascular system as anti-infectives and on the nervous system, which is not surprising considering the leading causes of death and disability worldwide.
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Affiliation(s)
- Rut Lucas-Dominguez
- Department of History of Science and Information Science, University of Valencia, Valencia, Spain.
| | - Antonio Vidal-Infer
- Department of History of Science and Information Science, University of Valencia, Valencia, Spain
| | - Adolfo Alonso-Arroyo
- Department of History of Science and Information Science, University of Valencia, Valencia, Spain
| | - Carolina Navarro
- Department of History of Science and Information Science, University of Valencia, Valencia, Spain
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Degli Esposti L, Sangiorgi D, Buda S, Degli Esposti E, Scaglione F. Therapy discontinuation or substitution in patients with cardiovascular disease, switching among different products of the same off-patent active substance: a 'real-world' retrospective cohort study. BMJ Open 2016; 6:e012003. [PMID: 27807083 PMCID: PMC5129038 DOI: 10.1136/bmjopen-2016-012003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The present study investigated the effects of switching to different products of the same off-patent active substance (brand name or generic) on therapy discontinuation or substitution with another molecule of the same class, in patients with cardiovascular disease treated with statins and antihypertensives in a 'real-world' setting. DESIGN A retrospective cohort study in a 'real-world' setting. SETTING Analysis of data performed by integrating administrative databases that included approximately two million individuals who are assisted by the National Health System from three Local Health Units located in three different regions of Italy. PARTICIPANTS All patients aged ≥18 years with at least one prescription of simvastatin, ramipril or amlodipine in the period 1 January to 31 December 2010 were included and followed up for 2 years. MAIN OUTCOME MEASURES Prescription refills occurring during follow-up were evaluated. Frequency of discontinuation of therapy or substitution with another molecule of the same class (eg, from simvastatin to a different statin) during follow-up was identified. RESULTS During follow-up, therapy discontinuation or substitution was found to be more frequent in patients switching to a different product of the same active substance compared with non-switching patients (11.5% vs 10.8% and 22.2% vs 20.8% (p=0.002), respectively, in the simvastatin group; 4.0% vs 3.5% and 24.6% vs 22.7% (p<0.001), respectively, in the amlodipine group). In the ramipril group, 8% of patients undertook a therapy substitution to another molecule; no trend towards a lower percentage of substitution was observed in the non-switching group, while 18% of patients discontinued treatment, with a significant difference in favour of patients not switching. These findings were partially confirmed by multivariate analysis. CONCLUSIONS Switches among products of the same active substance are quite common in patients with cardiovascular disease. Our study suggests that switching may expose patients to a higher risk of therapy discontinuation or substitution.
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Affiliation(s)
| | - Diego Sangiorgi
- CliCon S.r.l. Health, Economics and Outcomes Research, Ravenna, Italy
| | - Stefano Buda
- CliCon S.r.l. Health, Economics and Outcomes Research, Ravenna, Italy
| | | | - Francesco Scaglione
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
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Dunne SS. What Do Users of Generic Medicines Think of Them? A Systematic Review of Consumers’ and Patients’ Perceptions of, and Experiences with, Generic Medicines. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2016; 9:499-510. [DOI: 10.1007/s40271-016-0176-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Patients’ perceptions of generic drugs in Greece. Health Policy 2015; 119:1406-14. [DOI: 10.1016/j.healthpol.2015.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 09/14/2015] [Accepted: 09/21/2015] [Indexed: 11/18/2022]
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