Familiarity with substitution of prescription generics increases positive attitudes toward OTC generics

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Introduction of measures to stimulate increased sale of generics swept over the Nordic countries in the 2000s. In Sweden, in 2002, generics substitution for reimbursed prescription drugs was made mandatory and the switching rates rose over the years to reach almost 100%. Although generics policies seem to be reserved for the prescription drug market [1], a contagion effect has been observed in the market for over-the-counter (OTC) drugs. Soon after the Swedish state monopoly on the sale of pharmaceutical products was terminated and new measures to boost sales of generic prescriptions was put in place in 2009, new generic brands of the top-selling OTC analgesics emerged on the market, all with a lower price compared with previously established brands [2]. Since OTC drugs are usually excluded from pharmaceutical benefit schemes, it is reasonable to expect a demand for cheaper brands when such options exist. Albeit, time has shown that the original brands often hold their position as OTC market leaders.

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In a recently published paper, Håkonsen et al. explored consumer choice and attitudes towards generic OTC analgesics among Swedish adults who bought OTC analgesics at community pharmacies in one of the country’s three largest cities [3]. The study showed that a majority of respondents were positive to generic brands of OTC analgesics, i.e. seven in 10 confirmed that they would choose cheaper generic brands over the originals. However, there was also a considerable share who were apprehensive about the quality and safety of cheaper generics and remained loyal to the more expensive brands.

Furthermore, the authors wanted to gain insight into people’s knowledge of generic OTC analgesics in terms of the names of the active substances. Hence, the respondents were asked to assign the generic name of four active substances to six different brands. Only one in four assigned all four active substances correctly. The most common mistake was to assign paracetamol as the active substance in products with ibuprofen and vice versa. A majority of those who completed the task flawlessly were familiar with generics substitution of prescription drugs. These participants were also more positive towards generics in general and most likely to choose a cheaper generic brand.

Now that a range of drugs is being sold outside of pharmacies, it is more important than ever to raise the awareness of the different active substances of OTC analgesics and their properties. Due to an increase in the number of reported paracetamol-related intoxications in Sweden, the sale of tablets with paracetamol from non-pharmacy retailers was stopped in November 2018 [4]. This was followed by a considerable fall in sales of paracetamol that was evened out by increased sales of ibuprofen, which is an indication that people are either unaware or careless about when it is appropriate to use one drug instead of the other. It may also be that they do not know that the products contain different active ingredients and/or confuse the names.

The conclusion was that there is a predominantly positive attitude towards generic OTC analgesics among Swedish consumers. However, there seems to be a need for raised awareness of the names of the active substances, alongside increased knowledge of the drugs’ similarities and differences in effects and risk profiles. Better labelling of the packages and more counselling about OTC analgesics could improve consumers’ ability to differentiate between the different drugs.

Conflict of interest
The authors of the research paper [3] declared that there was no conflict of interest.

Abstracted by Helle Håkonsen of the School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Sweden.

Editor’s comment
Readers interested to learn more about perspectives on generics substitution are invited to visit www.gabi-journal.net to view the following manuscript published in GaBI Journal:

A review of patient perspectives on generics substitution: what are the challenges for optimal drug use

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1. Vogler S. The impact of pharmaceutical pricing and reimbursement policies on generics uptake: implementation of policy options on generics in 29 European countries - an overview. Generics and Biosimilars Initiative Journal (GaBI Journal). 2012;1(2):93-100. doi:10.5639/gabij.2012.0102.020
2. The Swedish Agency for Public Management. A re-regulated pharmacy market – Final report (2013:7). Stockholm: 2013.
3. Håkonsen H, Wängberg M, Alani D, et al. Generic versus brand-name over-the-counter analgesics: knowledge and attitudes among Swedish pharmacy customers. J Pharm Policy Pract 2020;13:60. doi:10.1186/s40545-020-00269-5
4. Gedeborg R, Svennblad B, Holm L, et al. Increased availability of paracetamol in Sweden and incidence of paracetamol poisoning: using laboratory data to increase validity of a population-based registry study. Pharmacoepidemiol Drug Saf. 2017;26:518-27.

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