In the poorest countries in the world, almost half of the people do not have adequate access to essential medicines. Generic medicines play an important role in improving access to medicines, as they can be 20–90% cheaper than their branded equivalents.

To promote generic drug use, governments across the globe have adopted generics substitution policies, which enable pharmacists to dispense a generic form of a branded drug prescribed by a doctor. This is particularly important for the developing world. Indeed, it has been estimated that switching procurement from branded drugs to generic equivalents in the private sector alone in 17 developing nations could cut spending by 60%.

In some European countries, such as France, Germany and Spain, generics substitution is already mandatory, which means pharmacists are required to substitute brand-name drugs with generic equivalents unless it is prohibited by the prescriber. In several others, it is permissive, which means pharmacists can substitute with a generic drug if they have patient consent.

In the Middle East however, uptake of generic drugs has been slower. In Lebanon, pharmaceuticals account for over a quarter of all healthcare spending. The same percentage of household expenditure goes to medications. This is high compared to other Organisation for Economic Co-operation and Development (OECD) countries and the rest of the Middle East. These high spending rates are largely because the pharmaceutical sector in Lebanon is dominated by patented, brand-name drugs, which have over 80% of the market share.

To tackle this, in 2010 the Lebanese Government approved a law that allowed pharmacists to substitute a brand-name drug for a generic version, provided that the patient and doctor agree to the substitution. One year later, the Ministry of Public Health further assisted the generic drug cause, by publishing a new ‘unified medical prescription form’, which permits generics substitution, to be used by patients, pharmacists and healthcare providers.

Although first revealed in 2010, due to administrative burdens and conflicts of interests, it took a further five years for these laws to be implemented. To assess their achievements since then, a study recently published in Implementation Science assessed pharmacists’ perceptions of the generic drug substitution policy and its implementation. The researchers interviewed over 150 pharmacies in Lebanon, identifying emerging challenges and barriers to the policy as well as strategies to improve future implementation. 

A more detailed discussion of the results is presented in the article that follows.

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

Related article
Barriers to generics substitution in the Middle East

Editor’s comment
Readers interested to learn more about generics substitution in low- and middle-income countries 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)

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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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