In developing countries, out-of-pocket payments are as high as 80% of healthcare spending [1]. Generic medicines can be instrumental in reducing this expenditure. A survey coordinated by the International Islamic University Malaysia aimed to explore the knowledge, perception and attitude of general practitioners towards generic medicines in Karachi, Pakistan [2].

The background
Worldwide, healthcare costs pose a burden of affordability of medicines. In Pakistan, healthcare spending is less than 3% of GDP and health care is mostly financed by private out-of-pocket payments [3]. More than 50% of the population of Pakistan earns less than US$2 (Euro 1.6) per day.  This huge segment of the population struggles to afford either prescription or non-prescription medicines.

In 1972, Pakistan undertook to promote generics competition. The Pakistani Drugs Act (Generic Names) forbade the prescription by brand or patented name, and manufacturing and selling of medicines under a proprietary name. The government’s objective was to place local manufacturers in competition with multinational companies, to drive down medicines prices. However, prices did not fall significantly because the issue shifted from price to quality.

Therefore, in 1976, the Director General of Health issued orders for another Drug Regulating Act, which ended the requirement to market drugs by their generic names and instead imposed stringent manufacturing licensing requirements.

Despite this, generic medicines in Pakistan only account for 50% of prescriptions [4]. So it is important to ask why generics are under-used in Pakistan. It may be part of a wider picture, in which the government is seen as untrustworthy or ineffective at enforcement.

The influence of general practitioners
General practitioners are not only involved in the diagnosis and treatment but they also dispense at their private clinics. This accounts for a large share of their income. This may be for a number of reasons: possibly to make money, unavailability of pharmacy services in the area, the absence of a pharmacist at community pharmacies, distrust of the medicines sold at pharmacies.

Thus, doctors in Pakistan exercise great influence on prescribing and dispensing. Older doctors, possibly with more bad experience of the government or of locally-sourced drugs, are less willing to prescribe generics than their younger colleagues.

The survey authors suggest that improved medical training should provide basic information on health policy, pharmaceutical policy, essential drug list, innovator and generic medicines, and their availability and affordability.

Conflict of Interest
None

Funding Source
The work [2] was supported by fellowship grant, Universiti Sains Malaysia, Penang, Malaysia

Editor’s comment
Readers interested to learn more on patient perspectives on generics substitution are invited to visit www.gabi-journal.net to view the following peer reviewed article published in 2012, Issue 1, in GaBI Journal:

A review of patient perspectives on generics substitution: what are the challenges for optimal drug use

If you are interested in contributing a research article in a similar topic to GaBI Journal, please send us your submission here.

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References

1.  World Health Organization [homepage on the Internet]. The World Medicines Situation WHO/EDM/PAR/2004.5  [cited 2012 Aug 17]. Available from: http://www.searo.who.int/LinkFiles/Reports_World_Medicines_Situation.pdf

2.  Jamshed SQ, Ibrahim MIM, Hassali MA, Masood I, Low BY, Shafie AA, et al. Perception and attitude of general practitioners regarding generic medicines in Karachi, Pakistan: a questionnaire based study. Southern Med Review. 2012;5(1):22-30.

3.  Pakistan Pharmaceutical and Healthcare Report Q3 2011. BMI Industry Report and Forecast Series Business Monitor International, (2011).

4.  World Health Organization [homepage on the Internet]. Pakistan Country Profile 2005. [cited 2012 Aug 17]. Available from: http://www.who.int/countries/pak/en/