Generic medicine: What’s in a name?
It is a year since generic substitution and reference pricing legislation were introduced
Generic medicines: contain the same active ingredient as the product they are based on. Photograph: Thinkstock
Kathy Maher, president of the Irish Pharmacy Union: role and workload of pharmacists has changed considerably. Photograph: Colm Mahady / Fennells
Atorvastatin, Lansoprazole, Olanzapine. Do you know what these names mean? If you do, it’s likely that your medicine, which you once called by its brand name, has been changed to a generic version that goes by the active ingredient name.
Atorvastatin is a drug used for the treatment of high cholesterol, and prevention of heart attack and strokes, while Lansoprazole belongs to a group of drugs called proton pump inhibitors that decrease the amount of acid produced in the stomach, and help treat reflux. Olanzapine is used in the treatment of schizophrenia and bipolar disorder.
Generic medicines are essentially copies of branded medicines and contain the same active ingredient as the product they’re based on. They are just as effective and just as safe. The only difference, apart from the name, packaging and sometimes the appearance, is that the generic version is usually available at a lower cost.
Generic medicine usage in Ireland has traditionally been very low; in 2007 just over 19 per cent of prescription items were dispensed generically, and generic prescribing accounted for just 8.2 per cent of total expenditure under the HSE’s medical card scheme.
Ireland is well known for its love of brands and willingness to pay higher prices for high-end products, from teabags to clothes to medicines, though the recession has helped encourage a more critical approach to affordability, by both State and patients.
Last June, the long-awaited Health (Pricing and Supply of Medical Goods) Act 2013, which provides for the introduction of a system of generic substitution and reference pricing for authorised medicines, was commenced in Ireland.
Previously, if a specific brand name medicine was prescribed, the pharmacist had to dispense this brand, even when less expensive versions of the same medicine were available.
Under the new law, the pharmacist may substitute the prescribed branded medicine for a safe and less-expensive generic version that has been deemed interchangeable by the Irish Medicines Board (IMB).
The first medicine to be deemed interchangeable was atorvastatin, with 96 atorvastatin products included on the list published last August in four separate groups.
Reference pricing means the HSE sets one price that it will pay for groups of medicines on the IMB’s interchangeable list. If you want your more expensive branded medicine, you have to pay for it.
Reference pricing, like generic interchangeability, is being introduced one medicine at a time, to ensure adequate supplies can be provided. The first reference price, for atorvastatin medicines, was published on November 1st, 2013.
The IMB is still working through the 40 active medicine substances prioritised for substitution by the Department of Health, due to their cost and volume of use.
To date, the board has published interchangeable groups for 23 active substances (including amoxicillin/clavulanic acid-containing products that were not on the original priority list), has initiated consultation on a further 12 active substances, and anticipates that consultation on the six remaining priority active substances will have begun by August.
AcceptanceSo, one year on, how have the changes been accepted by the medical community and patients?
The HSE, Department of Health and IMB created a health-education campaign in 2013 to support the new legislation and to help ensure a smooth introduction.
“We had to explain a complex new pricing system, which could potentially involve switching from a branded medication to a generic version, in a simple and clear manner.
“The campaign was also designed to assist GPs, pharmacists and other healthcare staff to fulfil their central role in supporting patients through these changes,” the HSE told The Irish Times.
The campaign includes a website, hse.ie/generics, and posters and leaflets were distributed to 1,750 pharmacies and more than 1,600 GP surgeries nationwide.
The pharmaceutical company Pfizer conducted consumer research to evaluate its reference pricing adverts to see how people’s knowledge, awareness and understanding had changed.
Before the campaign, 41 per cent of people said they had no awareness that they may be offered an equivalent medicine by the pharmacist; this reduced to 26 per cent afterwards. Before, 70 per cent of people said they had not heard the term reference price: this reduced to 50 per cent afterwards.