Generics saved consumers and the US healthcare system US$217 billion in 2012 and have saved the US in excess of US$1.2 trillion between 2003 and 2012, according to a report by the Generic Pharmaceutical Association (GPhA) [2].

Strategies to increase prescribing of generics and biosimilars include traditional information supplying programmes such as formulary decision support and academic detailing, as well as financial incentives.

In the following series of four articles Sarpatwari and co-authors discuss the types of substitution possible with generics and biosimilars, strategies used to promote prescribing of generics, as well as their legal and ethical considerations, and how these issues might apply to biosimilars.

The authors conclude that both interventions can be safely, legally and ethically employed by private insurers and employers to encourage bioequivalent substitution of non-narrow therapeutic index (NTI) generic, but further safety and effectiveness data are needed to recommend substitution of bioequivalent NTI or interchangeable biosimilars substitution.

Conflict of interest
AS Kesselheim’s (ASK) work is supported by an Ignition Award from the Harvard Program in Therapeutic Science. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors of the research paper [1] declared that they have read the journal's policy and declare the conflicts that ASK is a member of the Editorial Board of PLOS Medicine.

Related articles
Substitution of generics in the US

Substitution of biosimilars in the US

Promoting generics prescribing in the US

Considerations when promoting generics prescribing in the US

References
1.   Sarpatwari A, Choudhry NK, Avorn J, Kesselheim AS. Paying physicians to prescribe generic drugs and follow-on biologics in the United States. PLoS Med. 2015;12(3):e1001802.
2.   GaBI Online - Generics and Biosimilars Initiative. Generics save US 1.2 trillion over last 10 years [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2015 Mar 27]. Available from: www.gabionline.net/Reports/Generics-save-US-1.2-trillion-over-last-10-years 

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