To explore the attitudes and practices of pharmacists when it comes to generic drug substitution, the researchers randomly approached one pharmacy personnel from each selected community pharmacy, They used a cross-sectional mixed methods approach composed of self-administered questionnaires and semi-structured interviews to 153 community pharmacies in the country. This is the first study to assess implementation of Lebanon’s generic drug substitution policy, which was put into practice in 2015.

Although most (64%) pharmacists said they were in favour of generic drug substitution, only 40% said they had actually done this in practice. When asked why, almost 60% said the current pricing system discouraged them from substituting a brand-name drug for a cheaper, generic equivalent. This may be because pharmaceutical companies have lowered the prices of their brand-name drugs to compete with generic versions.  This, in turn, emphasizes the importance of establishing appropriate medicine prices and pricing systems to promote generic drugs.

Pharmacists were also less than positive about the new prescription form, with most (84%) agreeing that doctors overuse the ‘non-substitutable’ option on the form. They suggested having a maximum number of times this can be marked by a doctor per month to avoid its overuse. 

Pharmacists also described technical difficulties processing the new style prescription form. Over three quarters say consumers still bring the old prescription form to the pharmacy and almost 70% said consumers have expressed negative attitudes towards the form. Furthermore, less than half said that the Lebanese Ministry of Public Health (which introduced the policy changes) is performing regular checks on the forms collected by pharmacies.

Overall, only 37% of pharmacists support its current implementation and less than half think it promotes the use of generic drugs or helps to regulate the pharmaceutical industry.

Promisingly however, 45% said consumers have mostly accepted generic substitutions for brand-name drugs, over 20% consider the increase in generic drug prescribing to be ‘significant’. One third even described cases where consumers have actively requested a generic version of a drug and a further 34% said overall patient spending had decreased as a result of the policy.

Barriers to implementation include poor preparation and dissemination, poor adherence by some doctors, lack of trust in the quality of generics and infrequent monitoring.

The authors also found a connection between how informed people were about generic drugs and how much they supported generic drug substitution. As a result, they recommend educational and awareness raising campaigns for generic drugs. They also recommend improving government stewardship of the policy, efforts to improve commitment among doctors and pharmacists and establishing incentive systems.

The authors conclude that although the policy has good intentions, its realization has been weakened by problems with the new unified prescription form and a lack of incentive systems in place. They make a number of important recommendations, which they say have the potential to improve the implementation of Lebanon’s generic drug substitution policy.

Conflict of interest
The authors of the research paper [1] declared no competing interests.

Editor’s comment
Readers interested to learn more about generic substitution in the Middle East area are invited to visit www.gabi-journal.net to view the following manuscripts published in GaBI Journal:

Challenges of developing generics substitution policies in low- and middle-income countries (LMICs)

Pricing of biosimilars in Saudi Arabia

Readers interested in contributing a research or perspective paper to GaBI Journal – an independent, peer reviewed academic journal – please send us your submission here.

Related article
Generic drug substitution in Lebanon

Reference
1. El-Jardali F, Fadlallah R, Morsi R, Hemadi N, Al-Gibbawi M, Haj M, et al. Pharmacists’ views and reported practices in relation to a new generic drug substitution policy in Lebanon: a mixed methods study. Implementation Science. 2017;12(1):23.

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