A survey of physicians in the Philippines has revealed that five out of six drugs are prescribed using generic names, with physicians in the public sector prescribing generics significantly more often than those in the private sector [1].
The country was divided into six zones for the survey, namely: North Luzon, South Luzon, National Capital Region (NCR), Visayas, Mindanao and the Autonomous Region in Muslim Mindanao (ARMM). A total of 30 physicians were interviewed for the study, with the number of physicians interviewed per zone being based on the number of doctors in each zone. The interviews included questions on perceptions regarding generics, obstacles and barriers to prescribing generics and recommendations regarding the law (Generics Act of 1988) and its implementation.
The results showed that 89.47% of drugs prescribed by physicians in the public sector are generics compared to only 80.93% of drugs prescribed by physicians in the private practice (p = < 0.001). This varied by zone, from 80% in North Luzon to 95% in the ARMM.
When physicians were questioned on what they knew about the Generics Act of 1988 one opinion was that it is illegal to write the brand name on the prescription, while others believed that the brand name can be written provided the generic name is also written. Most physicians supported the generics prescribing provision because it was better for patients’ welfare. In fact, none of the physicians questioned directly said that they were not in favour of the provision, though some were not entirely supportive.
Physicians were asked to rate themselves from 1 to 10 on how often they prescribe generics. Of those that rated themselves as 10, they said that they did so because it was required by the law and punishable if not followed. For those who scored themselves less than 10, they did so because of concerns over the quality of generics and because they recall brand-name drug names better.
When questioned on generics prices, the physicians responded that they believed generics are cheaper because they are of poorer quality, there is less marketing/advertising/research/manufacturing/taxation costs and because they are off patent.
Worryingly, most physicians believe that generics are of poor quality, stating as reasons impure additives, increased side effects, doubts about the manufacturer, slow action of the drug and regulation problems. Some, however, did say that generics are of equal quality to brand-name drugs and a few answered that only some generics are of good quality but most are not.
Factors positively affecting generics prescribing behaviour are patient’s welfare, compliance, patient’s financial situation and fear of punishment. Quality concerns, lack of regulation by FDA, poor recall, patient’s preference and personal experience are factors that negatively affect generics prescribing behaviour. As a result almost all physicians mentioned that improved quality testing and regulation would help doctors trust the generics that are available in the market, and thus, increase generics prescribing behaviours. The authors therefore recommended that bioequivalence tests should be done to finally put an end to concerns on the quality of generics in the Philippines.
Reference
1. Wong JQ, et al. The Prevalence of Philippine Prescribing, Dispensing, and Use Behavior in Relation to Generic Drugs and their Risk Factors. Philippine Institute for Development Studies. Discussion Paper Series No. 2014-17.
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