Evaluating community pharmacists’ perspectives and practices concerning generic medicines substitution in Saudi Arabia: A cross-sectional study

Facilitators and barriers to generic and biosimilar medications in the Middle East and North Africa: insights from physicians and pharmacists-a systematic review

BACKGROUND

The adoption of generic and biosimilar medications is crucial for improving healthcare accessibility and cost savings in the Middle East and North Africa (MENA) region. Understanding the factors that influence their acceptance is crucial for developing effective strategies for promoting their use.

PURPOSE

This systematic review aimed to examine the facilitators and barriers identified by healthcare professionals while prescribing and dispensing generic and biosimilar medications in the MENA region, focusing on their perceptions, knowledge, and attitudes.

METHODS

Following Cochrane guidelines and the "Guidance on the Conduct of Narrative Synthesis in Systematic Reviews," a comprehensive search of electronic databases and grey literature was conducted from 2012 to 2024. Studies assessing physicians' and pharmacists' perspectives on generics and biosimilars in the MENA region were included. Quality appraisal was performed using a standardized tool, the mixed methods appraisal tool (MMAT). The findings were synthesized using a descriptive analysis.

RESULTS

Of the 3570 screened citations, 39 met the inclusion criteria. Among them, 25 studies addressed facilitators and barriers to adopting generic medications, whereas 15 focused on biosimilars. Facilitators of generic medications included understanding the use of generics as cost-effective substitutes, supportive government policies, generic medication awareness, and pharmacists' empowerment to substitute medications. Barriers included knowledge gaps leading to distrust in efficacy and safety, the influence of pharmaceutical companies, cultural biases favoring brand name drugs, regulatory challenges, low consumer awareness, and concerns about pharmacists' profitability. Facilitators for biosimilars were mostly similar to generics, with an added emphasis on access benefit recognition when using biosimilars. Unique barriers included concerns about the lack of long-term safety data, hesitancy toward non-medical switching, and nocebo effect concerns. The quality assessment indicated that most studies were of moderate quality, with limitations such as sample size and representativeness, validity of the measurement tools, and potential biases of the researchers.

CONCLUSION

Significant knowledge gaps regarding regulatory approval, safety, and efficacy hinder the adoption of generic drugs and biosimilars in MENA. Targeted educational initiatives at the regulatory and payer levels are essential for bridging these gaps, enhancing awareness, and fostering acceptance. Implementing comprehensive educational programs for physicians and pharmacists is crucial to support the transition toward the greater use of generics and biosimilars.

An exploration of factors influencing the selection of generic and innovator medicines in Saudi Arabia using an observational cross-sectional study

Background and objectives

Generic medications are cost-effective without compromising therapeutic outcomes. Therefore, the goal of this study was to investigate, using a cross-sectional study design, the factors influencing Saudi Arabian consumers' preferences between innovator and generic medications.

Methods

This cross-sectional study was carried out in Saudi Arabia using a Google survey form. For data collection, a simple random sampling strategy was used. The recruited participants were surveyed using a validated questionnaire that focused on six influencing domains: physician, pharmacist, perceived effectiveness, price, information availability, and confidence based on prior experience. The obtained data was used to analyze factors that have an association with any of the six domains using multinomial regression analysis. A correlation analysis was performed to examine the relationship between domains.

Results

The 317 participants included 64.4 % females, 52 % aged ≥ 26, and a large proportion of Saudi nationals (82.6 %) and university graduates (78.9 %). Being employed (OR:3.029; P = 0.006; CI: 6.715-1.366), a healthcare providers (OR:2.298; P = 0.043; CI: 5.151-1.025), and having insurance coverage (OR:1.908; P = 0.017; CI: 3.245-1.122) had a greater influence on medication selection. Participants with linguistic and business educational backgrounds (OR:3.443; P = 0.022; CI: 9.950-1.191), those living in the northern region of Saudi Arabia (OR:3.174; P = 0.009; CI: 7.585-1.328), having chronic ailments (OR:3.863; P = 0.013; CI: 11.274-1.324), and possess insurance (OR:1.748; P = 0.039; CI: 2.971-1.028) get readily influenced by pharmacist. People who were married and lived in Saudi Arabia's southern region were influenced by perceived effectiveness when choosing medicine. Participants from the northern region were found to be influenced by the price of the medicines, information about the medicines, and confidence based on previous experience. The price of medicines has a significant impact on those suffering from chronic diseases. At a significant level of P = 0.01, all six influencing domains were found to be positively correlated with each other.

Conclusion

The study shows that healthcare providers, drug prices, perceived efficacy, and information availability all have a big influence on the Saudi Arabian population's choice of medications. Educational background, location, and chronic disease status are associated with several influencing domains. Aside from public awareness campaigns, healthcare professionals should be involved in the implementation of the generic medication policy.

Access to Medicines and Pharmaceutical Policy in Saudi Arabia: A Scoping Review

Introduction

This scoping review includes studies on pharmaceutical access, shortages, generics, availability, pharmacoeconomics, and pricing restrictions. The study's findings may aid in developing excellent pharmaceutical and access policies in the country.

Objective

To conduct a scoping review documenting access to medicines and Pharmaceutical Policy in Saudi Arabia.

Methodology

The PRISMA-ScR guidelines were used to perform a scoping review. The articles were screened using databases from Google Scholar, EBSCO, Science Direct, and the University of Huddersfield Library. The selection, aims, results, and conclusion of each original research publication published between 2010 and 2022 were evaluated. To categorize the articles, a theme analysis was done.

Results

This study includes nineteen publications. The chosen articles revealed four themes. Among these topics were: Access to medications 36.84% Pharmacoeconomic 36.84%), which were the predominant theme followed by Generic Medicines 15.80%, and Cancer drug financing 10.54%. There are myriad challenges related to high-cost medicines. Access restrictions to medications have significant effects on patient morbidity and mortality; as a result, policy decision-makers frequently consider this issue. Access to medicines suffers budgetary limitations and the increasing cost of innovative medicines. Access to medicines for all patients could be significantly impacted by delays in patient access to new therapies.

Conclusion

The available evidence revealed that Saudi Arabia's healthcare system has numerous issues ranging from cancer drug financing, medicine shortages, and access issue. In order to achieve the highest health standards possible, it is crucial that each individual has access to medicines and has the financial, physical, and social means to do so. However, the price of some medications can be prohibitive for people who need to obtain them. The study's outcomes could help the country develop pharmaceutical and access policies related to medicines.

Generic Substitutions and Therapeutic Interchanges in Hospital Pharmacies: A Qualitative Study from Western Saudi Arabia

Background: The aim of the present study was to understand hospital pharmacists' views and practices regarding generic substitution and therapeutic interchange. Method: This was a qualitative study involving pharmacists from three Western Saudi governorates: Taif, Makkah, and Jeddah. It included respondents from the Ministry of Health (MoH), military and private hospitals. Pharmacists were selected using a convenient sampling technique and data were collected using a structured face-to-face interview. Results: Fifty-seven pharmacists agreed to participate in this study. In MoH and private hospitals, generic substitution is a pharmacist-initiated act, while therapeutic interchange requires physician approval. Medication unavailability, side effects, patient characteristics, outcomes, and economic status justified most substitution decisions. In military hospitals, both types of substitutions are controlled by an auto-switch policy and physicians should be informed. In all hospitals, there are policies regulating substitution. Medications eligible for interchange mentioned by pharmacists from different hospitals were comparable to some extent. Pharmacists from the private sector considered substitution a supportive economic measure for both hospitals and patients. Most pharmacists highlighted that patient convenience and physician approval are the most challenging situations in substitution practice. Conclusions: An enhanced understanding of substitution and knowledge about medications included in the hospital formulary will be valuable support to the implementation of substitution practice which responds to the patients' needs to improve their outcomes.

Assessment of community pharmacists' knowledge about drug-drug interactions in Jeddah, Saudi Arabia

Background: Drug-drug interactions (DDIs) have the potential to result in severe adverse drug events and profoundly affect patient outcomes. The pivotal role community pharmacists assume in recognizing and effectively managing these interactions necessitates a comprehensive understanding and heightened awareness of their implications. Such knowledge and awareness among community pharmacists are fundamental for ensuring the delivery of safe and efficacious care to patients. Aim: This study aimed to assess the knowledge of community pharmacists in Jeddah, Saudi Arabia, regarding drug-drug interactions (DDIs). Method: A cross-sectional survey was administered to a cohort of 147 community pharmacists through the utilization of a self-administered questionnaire. The questionnaire encompassed a comprehensive range of 30 multiple-choice questions, encompassing various facets pertaining to drug-drug interactions (DDIs). Results: A total of 147 community pharmacists working in Jeddah City, Saudi Arabia, completed the survey. The majority of them were male (89.1%, n = 131), and had bachelor's degrees in pharmacy. Results showed that the lowest correct response of DDIs was between Theophylline/Omeprazole, while the highest was between amoxicillin and acetaminophen. Results revealed that among the 28 drug pairs, only six pairs were determined correctly by most participants. The study found that majority of the studied community pharmacist could not determine the correct answer on drug-drug interaction knowledge, as also seen with the measured below half mean DDIs knowledge of 38.22 ± 22.0 (min = 0, max = 89.29, median = 35.71). Conclusion: The study highlights the need for ongoing training and education programs for community pharmacists in Saudi Arabia to enhance their knowledge and understanding of DDIs, ultimately leading to improved patient care and safety.

Factors facilitating and hindering counselling about generic substitution and a reference price system in community pharmacies - a survey among Finnish dispensers

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.

Knowledge, perceptions and practices of pharmacists regarding generic substitution in China: a cross-sectional study

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.

Exploring risk pooling in hospitals to reduce demand and lead time uncertainty

Nearly every eighth German hospital faces an elevated risk of bankruptcy. An inappropriate use of inventory management practices is among the causes. Hospitals suffer from demand and lead time uncertainty, and the current COVID-19 pandemic worsened the plight. The popular business logistics concept of risk pooling has been shown to reduce these uncertainties in industry and trade, but has been neglected as a variability reduction method in healthcare operations research and practice. Based on a survey with 223 German hospitals, this study explores how ten risk pooling methods can be adapted and applied in the healthcare context to reduce economic losses while maintaining a given service level. The results suggest that in general risk pooling may improve the economic situation of hospitals and, in particular, inventory pooling, transshipments, and product substitution for medications and consumer goods are the most effective methods in the healthcare context, while form postponement may be unsuitable for hospitals due to the required efforts, delay in treatments, and liability issues. The application of risk pooling in healthcare requires willingness to exchange information and to cooperate, adequate IT infrastructure, compatibility, adherence to healthcare laws and regulations, and securing the immediate treatment of emergencies. Compared to manufacturing and trading companies, hospitals seem to currently neglect the variability reducing effect of risk pooling.

Knowledge, attitudes, perceptions and practices of community pharmacists about generic medicine in Nigeria

Background

Although generic medicines are used extensively in Nigeria information from community pharmacists about these drugs are scanty and therefore inadequate. This is why this study has been designed to bridge the knowledge gap, attitudes, as well as the perception and practice of community pharmacists about generic medicines in Nigeria.

Method

A questionnaire-guided cross-sectional survey was used to collect data from 380 community pharmacists who were randomly selected from community pharmacies between April and June 2019 in Southwestern Nigeria. Data generated in the course of this study was analysed with the Statistical Package for Social Sciences version 18. Descriptive statistics were used to summarize data. Chi-square was used to test proportions and to determine associations between categorical variables. Pearson’s Correlation Coefficient was used to determine correlation between dependent variables.

Result

Mean knowledge score of community pharmacists about generic medicines(GM) was 5.6 ± 2.9 out of a total maximum score of 10. Results showed that 47.9% of respondents had poor knowledge, 27.6% average knowledge and 24.5% good knowledge about GM. Knowledge was significantly associated (p = .000) with all demographic characteristics except professional qualifications. A majority (89%) of the respondents were of the view that patients need more explanations when GMs are dispensed to them. In addition, 90.3% of the respondents were of the opinion that GM will improve access to medicine because they are cheaper and easily affordable. About 93% practice generic substitution without consulting prescribing physicians. Furthermore, 85% of the respondents claim they stock mainly GMs.

Conclusion

Community pharmacists in Nigeria had a positive attitude, perception and practice about GM, but exhibited sub-optimal knowledge in understanding issues concerning generic medicines. It is concluded that there is the need for continuous training and education to enhance professional knowledge of pharmacists in the area of GM substitution.

Public knowledge, perception, and experience with generic medications in Saudi Arabia

Objectives:

To assess the public knowledge and perception about generic medications in Saudi Arabia, and their willingness to use generic medications.

Methods:

This cross-sectional, online-questionnaire-based study was conducted between May and July 2019, including participants who can read and complete an Arabic online survey. Chi-square test and contingency coefficient were used to investigate differences in different segments of participants and assess the association between knowledge and perception.

Results:

A total of 397 participants have completed the survey. One-half of them were female, the majority were of young age (<35 years), and 40% of them were buying their medications independently. Only 40.5% of participants had adequate knowledge and 60% of them had positive perception on generics. Participants with higher level of education were more likely to have adequate knowledge (p=0.002) and positive perception (p=0.006). The study found a moderate relationship between knowledge and perception about generics (standardized C=0.35, p<0.001). The country of origin for medications was a significant indicator of quality for two-thirds of participants, and one-half of them believed that local generics can compete with imported ones. About one-half of participants used generics and the majority of them were satisfied with their experience.

Conclusion:

There is a general lack of knowledge, while having a positive perception on generic medications among the general public in Saudi Arabia. Future studies should focus on strategies to improve it and assess its cost-savings consequences while maintaining quality of care.

The content of patient counseling about interchangeable medicines and generic substitution in Finnish community pharmacies - a survey of dispensers

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.

Medication safety problems priorities in community pharmacy in Saudi Arabia: a multi-stakeholder Delphi study using the human factors framework

AIM

To achieve multi-stakeholder consensus and prioritisation of medication safety problems in community pharmacies in Saudi Arabia.

DESIGN AND INTERVENTION

A theoretically-underpinned, three-round Delphi study.

SETTING

Saudi Arabia.

PARTICIPANTS

Patients and public (pharmacy users), pharmacy-related professionals (policymakers, academics, medication safety officers and pharmacy owners) and community pharmacists.

METHODS

Round 1 comprised 84 statements derived from a qualitative study. The items were grouped according to the Human Factors Framework (HFF). Rounds 1 and 2 aimed to achieve consensus, 6-point Likert response scale (agreement/disagreement) was used. Round 3 aimed to prioritise the items for which consensus was achieved in Rounds 1 and 2 indicated on a 5-point scale (very important to unimportant). Consensus was predefined as any item that achieved ≥70%.

RESULTS

The number of respondents in Rounds 1, 2 and 3 was 161, 120 and 112, respectively. In all three rounds, the majority of respondents were pharmacy users (Round 1 77% (n=124), Round 2 74% (n=89), Round 3 72% (n=81)). Consensus was achieved with 28/84 items. The top five medication safety priorities were: lack of pharmacy facilities such as counselling area, lack of communication between pharmacists and physicians, lack of patient databases, lack of post-registration pharmacist education and pharmacists' long working hours. The professional and pharmacy user groups achieved consensus on similar items through different categories of the HFFs. Community pharmacists had the highest percentage of consensus among the three groups for factors related to work, such as high workload and low salaries.

CONCLUSION

This multi-stakeholder study used the HFF to identify and prioritise the main medication safety challenges facing community pharmacy in Saudi Arabia. It indicates the need for changes to practice and policy and further research to address these priorities and promote medication safety at an individual, pharmacy and population level.

Pharmacists' views and reported practices in relation to a new generic drug substitution policy in Lebanon: a mixed methods study

BACKGROUND

Governments in both developed and developing countries have adopted generic drug substitution policies to decrease pharmaceutical expenditures and improve access to medicine. In August 2015, the Ministry of Public Health (MOPH) in Lebanon introduced generic drug substitution and a unified medical prescription form as policy instruments to promote generic drug use. The objective of this exploratory study was to examine the attitudes of community pharmacists and the reported practices in relation to the implementation of the new generic drug substitution policy.

METHODS

We used a cross-sectional mixed methods approach composed of self-administered questionnaires and semi-structured interviews. The study population consisted of community pharmacists in Lebanon. We randomly approached one pharmacy personnel from each selected community pharmacy. We conducted descriptive analyses to assess responses to questionnaire and regression analyses to understand associations between responses and respondent demographics. We analyzed qualitative data thematically.

RESULTS

Out of 204 invited community pharmacies, 153 pharmacies participated (75% response rate). The majority of respondents (64%) were in favor of generic drug substitution; however, less than half (40%) indicated they have substituted brand drugs for generic equivalents. Moreover, 57% indicated that the existing pricing system discourages them from performing generic drug substitution. Most respondents indicated that physicians are overusing the "non-substitutable" option (84%) and that there are technical problems with processing the new prescription form (78%). Less than half (47%) reported that the MOPH is performing regular audits on the forms collected by the pharmacy. While 45% of the respondents indicated that consumers have accepted most of the generic substitutions, 21% perceived the increase in generic drug dispensing to be significant. Findings suggested a potentially significant association between being informed about generic drugs and respondents' support of the policy. Suggested strategies to address implementation challenges included strengthening stewardship function of MOPH, securing full commitment of health care providers, conducting educational and awareness campaigns about generic drugs and generic drug substitution, and aligning incentive systems of the key stakeholders.

CONCLUSIONS

The majority of community pharmacists were supportive of generic drug substitution in general but not of the current implementation of the policy in Lebanon. Findings revealed implementation challenges at the provider, patient, and system level which are hindering attainment of the policy objectives. The key lessons derived from this study can be used for continuous improvement of the policy and its implementation.