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

Intr oduction With a few exceptions, e.g. Ireland and the UK, generic drug use has been promoted in western countries by allowing pharmacists to substitute drugs defined as therapeutically equivalent generics. Although this enables cost savings, which can slow growing pharmaceutical budgets, concerns have been raised regarding the possibility of such substitution leading to a higher overall healthcare expenditure [1]. The core of these concerns is that problems may arise when a brand-name drug, with which the patient is familiar, is replaced by a product with a different name and with other physical attributes, e.g. shape, size, and colour. This wellintentioned cost-containment strategy might contribute to sub optimal drug use and thereby increase morbidity and overall costs in a wider perspective depending on the extent that this strategy interferes with patients’ prescription drug-taking behaviour. Currently, patients with chronic medical conditions are increasingly affected by substitution reforms because they consume more drugs over a longer period of time and the generics interchangeable markets are expanding in response to policy changes and expiration of patents.