Ferrario et al. give examples of generics enabling greater access to care as including drugs for the treatment of human immunodeficiency virus (HIV) and hepatitis C in low- and middle-income countries. They add that the ‘availability of generics has also been linked with increased use of three antineoplastic medicines (capecitabine, imatinib and decitabine) in China and of an anti-platelet medication (clopidogrel) in lower-income European countries’.

However, despite progress in the availability and use of generics and biosimilars, the authors believe that ‘there is potential for more competitive prices and greater uptake’. They point to a study, carried out in 2013, which found wide variation in both the prices and market share of generics in Europe. One example of this was the prices charged by wholesalers in Switzerland, which were more than six times higher than those in the UK.

The authors also point out the huge disparity between generics and biosimilars. While generics competition has been shown to reduce prices by up to 66% compared with the originator before patent expiry, similar reductions have not been seen for biosimilars. This, they say is partly due to the complex production process and greater regulatory requirements for biosimilars, which, Ferrario et al. say ‘create barriers to market entry for competitors’.

The authors conclude that to increase their use ‘trust in the quality, safety, and bioequivalence of generics and biosimilars is essential’. ‘Timely entry in the market is also important for uptake’. In addition, they add that ‘implementation of international non-proprietary prescribing and generics substitution are key enablers of greater uptake in countries at all levels of income. Finally, Ferrario et al. state that ‘emphasis on increasing access for patients and quality of care rather than cost saving is likely to be a more convincing argument to forge successful partnerships with patients, prescribers, and dispensers who are responsible for implementing these policies’.

Conflict of interest
Several of the authors of the research paper [1] reported conflict of interest, including having received personal fees from the World Health Organization (WHO) and the European Society for Medical Oncology (ESMO) and having received grants from the Swiss National Science Foundation. For full details of the authors’ conflict of interest, see the research paper [1].

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Reference
1. Ferrario A, et al. Strategies to achieve fairer prices for generic and biosimilar medicines. BMJ. 2020;368:l5444. doi:https://doi.org/10.1136/bmj.l5444

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