Pharmacists' Individual and Organizational Views on Generic Medications
Pharmacists' Individual and Organizational Views on Generic Medications
Objective: To provide an overview and interpretation of the views of pharmacists and their professional organizations on the use of generic medications.
Data Sources: Articles indexed under terms such as generic medications, generic drugs, multisource medications, or multisource drugs. These terms were used to search indexing services such as MEDLINE, International Pharmaceutical Abstracts, CINAHL (a database of nursing and allied health literature), Science Citation Index, Psychological Abstracts, and Wilson Indexes to Journal Articles. The literature search was supplemented by a telephone survey of five major national pharmacists' organizations.
Study Selection: Performed by the authors.
Data Synthesis: Both community and hospital pharmacists generally support generic medication use. However, they continue to have concerns about generic substitution of medications in certain classes, such as those with a narrow therapeutic index. Pharmacists also have concerns about pressure from managed care to mandate generic substitution. The perceived effects of patient preferences are less significant. After the decision is made to dispense a generic product, the selection of a supplier is driven less by price than by the confidence pharmacists have in the supplier. While product quality is given as a key determinant of the specific product chosen, how pharmacists assess that quality is not well documented. Three pharmacists' professional organizations have policy statements on the use of generic medications, and these statements are generally supportive of the role of the pharmacist in drug product selection. Two organizations have also addressed the issue of therapeutic interchange and the need for collaborative efforts with physicians in this area.
Conclusion: Despite pharmacists' general acceptance of generic medications, issues surrounding their use, along with the growing importance of therapeutic interchange, are likely to remain matters of concern for pharmacists and their professional organizations.
The use of generic medications has increased significantly since the repeal of the last of the state antisubstitution laws in the early 1980s. Today, there are probably few pharmacists, particularly in ambulatory care settings, who do not practice some level of generic substitution. Not surprisingly, then, the literature on pharmacists' views on generic substitution has shifted from assessing whether pharmacists accept generic medications to addressing how they go about providing generic medications instead of the brand products. This practice, which is increasingly referred to as drug product selection, has been more traditionally known as generic substitution.
But some issues remain unresolved for pharmacists. These issues include differences in pharmacists' attitudes toward generic medications by their practice setting, the generic substitution of drugs with narrow therapeutic indices (NTI), perceived pressure from managed care plans and other insurers to contain costs by substituting generic medications for branded products, and the quality of generic products across suppliers, to name a few.
In this article we provide an analysis of these issues through a review of the pertinent literature published over the last decade. Using six indexing services (MEDLINE, International Pharmaceutical Abstracts, CINAHL [a database of nursing and allied health literature], Science Citation Index, Psychological Abstracts, and Wilson Indexes to Journal Articles), we identified and reviewed articles using keywords such as generic medications, generic drugs and multisource medications, or multisource drugs. In addition, we contacted several pharmacy organizations to ascertain their official policy statements on generic drugs.
This article is one of three in this issue of JAPhA that consider attitudes toward generic drugs and their use. The other two review articles discuss the perceptions of physicians and consumers.
Objective: To provide an overview and interpretation of the views of pharmacists and their professional organizations on the use of generic medications.
Data Sources: Articles indexed under terms such as generic medications, generic drugs, multisource medications, or multisource drugs. These terms were used to search indexing services such as MEDLINE, International Pharmaceutical Abstracts, CINAHL (a database of nursing and allied health literature), Science Citation Index, Psychological Abstracts, and Wilson Indexes to Journal Articles. The literature search was supplemented by a telephone survey of five major national pharmacists' organizations.
Study Selection: Performed by the authors.
Data Synthesis: Both community and hospital pharmacists generally support generic medication use. However, they continue to have concerns about generic substitution of medications in certain classes, such as those with a narrow therapeutic index. Pharmacists also have concerns about pressure from managed care to mandate generic substitution. The perceived effects of patient preferences are less significant. After the decision is made to dispense a generic product, the selection of a supplier is driven less by price than by the confidence pharmacists have in the supplier. While product quality is given as a key determinant of the specific product chosen, how pharmacists assess that quality is not well documented. Three pharmacists' professional organizations have policy statements on the use of generic medications, and these statements are generally supportive of the role of the pharmacist in drug product selection. Two organizations have also addressed the issue of therapeutic interchange and the need for collaborative efforts with physicians in this area.
Conclusion: Despite pharmacists' general acceptance of generic medications, issues surrounding their use, along with the growing importance of therapeutic interchange, are likely to remain matters of concern for pharmacists and their professional organizations.
The use of generic medications has increased significantly since the repeal of the last of the state antisubstitution laws in the early 1980s. Today, there are probably few pharmacists, particularly in ambulatory care settings, who do not practice some level of generic substitution. Not surprisingly, then, the literature on pharmacists' views on generic substitution has shifted from assessing whether pharmacists accept generic medications to addressing how they go about providing generic medications instead of the brand products. This practice, which is increasingly referred to as drug product selection, has been more traditionally known as generic substitution.
But some issues remain unresolved for pharmacists. These issues include differences in pharmacists' attitudes toward generic medications by their practice setting, the generic substitution of drugs with narrow therapeutic indices (NTI), perceived pressure from managed care plans and other insurers to contain costs by substituting generic medications for branded products, and the quality of generic products across suppliers, to name a few.
In this article we provide an analysis of these issues through a review of the pertinent literature published over the last decade. Using six indexing services (MEDLINE, International Pharmaceutical Abstracts, CINAHL [a database of nursing and allied health literature], Science Citation Index, Psychological Abstracts, and Wilson Indexes to Journal Articles), we identified and reviewed articles using keywords such as generic medications, generic drugs and multisource medications, or multisource drugs. In addition, we contacted several pharmacy organizations to ascertain their official policy statements on generic drugs.
This article is one of three in this issue of JAPhA that consider attitudes toward generic drugs and their use. The other two review articles discuss the perceptions of physicians and consumers.
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