Overview of research on ‘specific’ policies aimed at generics in 2012

Period: January to August 2012

Countries around the world have embraced generics due to their cost-saving potential. Many governments already have policies in place to promote the use of generic medicines, and as health systems face continuous cost pressures and demands to invest in new technologies, generics can only become more important.

The use of policies to increase prescribing or use of generics can only help to increase the cost-saving advantages that generics can bring about, making it an important area for governments to consider.

This article discusses some of the research papers covering the area of specific generics policies that have been published during the period of January to August 2012. Topics investigated by researchers included the effects of co-payment policies and how quality circles for pharmacotherapy (QCPs) for general practitioners (GPs) had changed prescribing behaviour.

Policies for patients
In a study carried out in Abu Dhabi, Abuelkhair et al. investigated how generics policies introduced in the country have affected the use of proton pump inhibitors (PPIs) and lipid-lowering drugs [1-4]. The authors carried out an uncontrolled before-and-after observational study of utilization and expenditure of PPIs, statins and ezetimibe between 2004 and 2010, as well as up to 12 months before the first generics policy and up to one year after the second generics policy was introduced in Abu Dhabi.

The results showed that PPI utilization had risen by 6.5-fold from 2004 to 2010, principally driven by increased utilization of patent-protected PPIs, with a similar situation being observed for statins. Introduction of pro-generics practices, such as automatic substitution at the pharmacy level, was estimated would reduce PPI expenditure in 2010 by Euros 6.26 million and statins by over Euros 5.15 million. The authors concluded that limited demand-side measures led to increased utilization of patent-protected products in Abu Dhabi following generic medicine reforms [1].

A study by Lee et al. examined the effect of new Korean pricing and co-payment schemes for pharmaceuticals with respect to: (1) patient drug expenditure, utilization and unit prices of overall pharmaceuticals; (2) utilization of essential medications and (3) utilization of less costly alternatives to the study medication [5].

The results of the study showed that patient drug expenditure fell gradually after the introduction of the co-payment scheme, and by as much as 12% in the first year after the introduction of the policy. However, the research also found that the policies under consideration appear to contain costs not by the intended mechanisms, such as by substituting generics for brand-name products, but rather by reducing patients’ access to costly therapies regardless of clinical necessity. In fact, the number of patients filling their anti-hyperlipidemics prescriptions decreased by 18% during the study period. Those prescribed generic and brand-named anti-hyperlipidemics declined by around 16% and 19%, respectively, indicating little evidence of generics substitution resulting from the co-payment increase.

Policies for doctors
In a study carried out in Austria, authors Spiegel et al. investigated whether the policy of introducing QCPs, for GPs had increased generics use in the country [3].

The authors identified that there are seven main topics which provide insight into various aspects of patient care in primary care – QCPs work, generic drug prescription, problems related to the sale of generics, patient counselling and education, therapy adherence, coordination of care, competence and medical education. Their investigation found that the percentage of generics prescribed by Austrian GPs had increased from 33.91% of all prescribed drugs for which generics were available in the fourth quarter (4Q) of 2003 to 43.97% in 4Q 2004 and to 49.88% in 4Q 2006 [6].

The research concluded that peer review groups can be an important method of quality improvement in GPs’ prescribing behaviour in favour of generics. The use of QCPs were also found to facilitate exchanges between GPs on problems encountered, as well as providing feedback to policymakers.

The research highlights the importance of having specific policies in place to promote the prescription of generics by doctors and promote the use of generic medicines by patients. Introducing policies which increase the use of generics can, in turn, lead to greater savings not just to patients, but also to governments and health insurers alike.

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References

1. Abuelkhair M, Abdu S, Godman B, Fahmy S, Malmström RE, Gustafsson LL. Imperative to consider multiple initiatives to maximize prescribing efficiency from generic availability: case history from Abu Dhabi. Expert Rev Pharmacoecon Outcomes Res. 2012;12(1):115-24.

2. GaBI Online - Generics and Biosimilars Initiative. Use of generics in Abu Dhabi [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2012 Dec 14]. Available from: www./gabionline.net/Generics/Research/Use-of-generics-in-Abu-Dhabi

3. GaBI Online - Generics and Biosimilars Initiative. Suggestions for increasing generics use in Abu Dhabi [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2012 Dec 14]. Available from: www.gabionline.net/Generics/Research/Suggestions-for-increasing-generics-use-in-Abu-Dhabi

4. GaBI Online - Generics and Biosimilars Initiative. Maximising the potential of generics in Abu Dhabi [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2012 Dec 14]. Available from: www.gabionline.net/Generics/Research/Maximising-the-potential-of-generics-in-Abu-Dhabi

5. Lee IH, Bloor K, Hewitt C, Maynard A. The effects of new pricing and copayment schemes for pharmaceuticals in South Korea. Health Policy. 2012;104(1):40-9.

6. Spiegel W, Mlczoch-Czerny MT, Jens R, Dowrick C. Quality circles for pharmacotherapy to modify general practitioners’ prescribing behaviour for generic drugs. J Eval Clin Pract. 2012;18(4):828-34.

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