Christine Leopold of Gesundheit Österreich, Vienna, Austria, and co-authors looked at monthly health sales data for antipsychotic medicines in Portugal and Finland between January 2007 and December 2011 [1]. Alterations to pharmaceutical policy in both Finland and Portugal led to increases in generics market shares of major antipsychotic products, but also a slight decrease in the use of antipsychotic medicines overall.

Portugal and Finland altered their policies in very different ways. Finland introduced a well-prepared mandatory generics substitution policy in April 2003 [2], requiring pharmacists to substitute higher-priced brand-name medicines with less costly generics. Portugal’s approach was less uniform, comprising a mix of cost-containment measures, including statutory discounts granted to public payers, changes in reimbursement rates and a generics campaign [3], that were ongoing before and after October 2010.

The most frequently sold active substances in both countries (clozapine in Finland and risperidone in Portugal) did not increase in generics market share, but this was for very different reasons. Risperidone already had a 90% share of the market in Portugal, so this was unlikely to increase significantly. In Finland, meanwhile, clinicians might have been reluctant to switch patients from clozapine to generic alternatives due to reports of worsening clinical status associated with generics substitution [4]. 

Nevertheless, two of the three leading active substances in the antipsychotic class (quetiapine and risperidone) experienced substantial increases in generics market share in Finland. While in Portugal, the combination of policies resulted in a major increase in generics market share for one molecule, amisulpride. The slight decrease in the use of antipsychotic medicines overall was a concern, since these drugs might have been needed more, rather than less, during an economic recession.

The findings highlight the importance of examining the long-term effects of policy measures.  The authors conclude that: ‘Increases in cost-sharing may have beneficial short-term impacts on public spending, but might also entail unintended long-term reductions in utilization, particularly for economically disadvantaged populations’.

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

Generics policies–a globally-relevant implementation challenge

The potential of generics policies: more room for exploitation–PPRI Conference Report

Pharmaceutical policy interventions in times of economic recession

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References
1.   Leopold C, et al. Impact of pharmaceutical policy interventions on utilization of antipsychotic medicines in Finland and Portugal in times of economic recession: interrupted time series analyses. Int J Equity Health. 2014;13:53.
2.   GaBI Online - Generics and Biosimilars Initiative. Factors important for generics substitution in Finland [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2014 Oct 24]. Available from: www.gabionline.net/Generics/Research/Factors-important-for-generics-substitution-in-Finland 
3.   GaBI Online - Generics and Biosimilars Initiative. Austerity measures introduced in Portugal affect generics [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2014 Oct 24]. Available from: www.gabionline.net/Policies-Legislation/Austerity-measures-introduced-in-Portugal-affect-generics 
4.  Kluznik JC, Walbek NH, Farnsworth MG, Melstrom K. Clinical effects of a randomized switch of patients from clozaril to generic clozapine. J Clin Psychiatry. 2001;62 Suppl 5:14-7; discussion 23-4.

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