This article is aimed at understanding the retail chemists prescription substitution practices using similar alternatives (branded generics) along with the demographics of the purchasers accepting such substitutions. Currently, almost all medicines in India are sold under a brand (trade) name and medicines are called as branded medicines or brandedgeneric. In real sense, Indian market does not have branded medicines (a name commonly given to an innovator product) because till January 2005 product patent was not applicable in India. In India, many pharmaceutical companies manufacture two types of products for the same molecule, i.e. the branded product which they advertise and push through doctors and branded-generic which they expect retailers to push in the market. The so-called branded medicines in India are manufactured and promoted by multinationals or by reputed Indian manufacturers. Branded-generics, on the other hand, are not promoted or advertised by the manufacturer. This category closely resembles formulations referred to as 'generics' worldwide. Patients' and doctors' perception for all branded-generics irrespective of company is the same.
In India, generic substitution is legally not allowed so patients' awareness about generics is limited and doctors and patients do not want pharmacist to change the trade name written by doctor. Hence, consumer awareness for the generics, variety of trade names available in the market, and price variation is very limited. Hence, there is need to conduct a study that can document the prescription substitution of the branded products by their branded-generic versions manufactured in India.
Keywords
Prescription substitution, Branded generics, Therapeutic and Sub-therapeutic
groups
1. Introduction Pharmaceutical marketing in India is quite a challenge due to highly fragmented nature of the market, with over 60,000 brands battling for a share in the prescription market valued at Rs. 64,500 Crores growing at 16% (AIOCD AWACS May 2012).
Most of the players in the market are small-to-medium enterprises, and 250-300 companies in the organized sector control over 70% of the Indian pharmaceutical market. All of the players are fighting out intensively and extensively in the doctors’ chambers to get prescriptions for their brands at a huge cost deploying often desperate practices. On an average, a pharma company spends roughly 10-12 percent of its sales revenues on promotional campaigns.
The hard fought and won brand prescription when elicited from the doctors chambers can be easily lost to a multiple of factors prevailing in the market particularly at the retail level. This loss or leakages of brand prescription can be substantial for both, large brands as well as forthe fledgling brands.
Chemists often substitute branded generics for branded drugs prescribed by doctors if approved by both, the prescribers and patients. Only, the substituted product must be therapeutically equivalent to the original product. Any differences in terms of preservatives used between the branded generic and original product has no clinical disadvantage for the patients. Many a time, patients to whom brands are prescribed are unaware that their prescribed brand has more economical alternatives. Considering the trade incentives doled out by pharmaceutical companies, the chemists are motivated to push or substitute the prescriptions coming to their counters. Various factors influence the substitutions atthe chemists’ counters.
Presently, we know little about the prescription substitution practices that is happening at the chemist’s level with branded generics, and the profile of patients who are willing to accept such substitutions with the branded generics. This pilot study tries to find out the brand name requests and substitution that is happening across therapeutic class and sub-therapeutic class, and the demographics of purchasers accepting these substitutions
2. Rationale of the Study
“Prescription substitution by branded generics: a pilot study of live
prescriptions in Mumbai suburbs” is important and helpful because of the
following reasons;
a) To understand the therapeutic and sub-therapeutic group-wise brand
prescription requests given by doctors.
b) To know the extent of prescription substitution carried out by the retail
chemists
c) To understand the profile of purchasers with whom prescription substitution
happens
d) The study is also helpful to find the actors involved in influencing the
prescription substitution
e) This study would help to provide an overview to companies to take necessary
proactive measures to reduce or minimize their brand substitution
3. Objectives of the Study
Following are the objectives of the study;
a) To understand the prevalence of prescription substitution happening at the
retail chemist level
b) To identify therapeutic and sub-therapeutic group-wise prescription
substitution
c) To know the type of prescription substitution happening at the retail
level
d) To find out the demographic profile of purchasers with whom prescription
substitution was effected
4. Research Methodology
4.1 Data Collection
The data was collected through following sources;
Primary Data The primary data was collected by first identifying an area in the suburbs of Mumbai, and then, a convenience sampling was done to identify two chemists. This was followed by selecting six Consulting Physicians (CP). The physicians selected were on the basis of convenience sampling, whose prescriptions were predominantly dispensed by the identified two chemists.
To collect the required primary data following tools/techniques of data
collection was used.
• Live prescriptions of the six selected doctors
• Questionnaire for the purchaser of medicines
• Interaction with purchasers and field visits
The prescriptions of the CPs were obtained from the patients after the purchase of the medicines has been affected. The actual prescription given to the patients by the doctors were compared with the medicines purchased by the patients for analysing the level of substitution done by the chemists.
A total of 120 new prescriptions generated by the six CPs which were dispensed by the two chemists were analysed over two consecutive days. Repeat purchase of medicines through earlier prescription was excluded from this study. A demographic profiling of the purchaser (need not be the patient) of the medicine was also carried out.
The confidentiality of the involved stake holders viz; doctors, purchaser and retail chemists were strictly maintained.
4.2 Secondary Data
Secondary data are essential for structuring and
planning the research approach. The secondary data for this research
has
been collected from;
• Research papers published on the subject
•
Industry and research journals and publications
• Magazines,
Newspapers and internet
4.3 Data Processing
The data collected was systematically processed,
classified and tabulated. After tabulation, analysis and interpretation was
done by using Excel. For the purpose of analysis, interpretation and to
summarize the findings, methods and techniques like percentage and graphical
charts were used.
4.4 Scope of the study
The scope of this pilot study is restricted to one specific area in Mumbai
suburbs. This live prescription study was made by the researcher for just two
consecutive days only. Therefore, the scope of the study is restricted to the
said two days only and in the concerned area only. Thus results, inferences
and conclusions are related and suitable for that area only, and may or may
not be applicable to other areas of Mumbai or any other part of the state or
country.
4.5 Limitations of the study
The pilot study has been done for just two consecutive days involving live
prescriptions from small sample size of six Consulting Physicians (CP) and two
chemists catering to those prescriptions (some prescriptions of the CPs may
not have got captured by the identified chemists). Also, the number of live
prescriptions analysed by the researcher is limited to 120. Whatever data
collected during the two days was utilised for the study. If there is some
variation in the data,then the result and conclusions may not be the same
All the conclusions are drawn on the basis of the prescriptions given by the CPs and the information provided by the purchasers of the medicines. There may be a possibility of deficiencies in the data collected. However, best efforts have been putto conduct correct and reliable data from the purchasers.
5. Review of Literature
• V. Tandon, B. M. Gupta, V. Khajuria in their Research Letter titled
“Therapeutic substitution: A hidden irrationality” published in
Indian J Pharmacol June 2004 Vol 36 Issue 3;175-180: indicates drug
substitution is done quite often by the pharmacist. This prospective study was
carried out for evaluating the patient prescriptions showing drug
substitution, generic substitution and therapeutic substitution. The drug
prescription substitution was seen across various therapeutic groups. The
study reveals drug substitution to be quite prevalent in the society.
• D B Anantha Narayana, Kusum Devi, Asha A N, Nimisha Jain, Uday Bhosale,
T Naveen Babu in a Feature Article titled “Report of an all India
Quantitative study of Consumer perceptions, availability, role, services
provided, medicines and expectations of pharmacists in India.” Published
in Pharma Times; have studied in general the extent of brand substitution by
chemists by informing the patients, not informing the patients, not
substituting at all, and also the reasons for such substitutions.
• Chee Ping Chong, Mohamed Azmi Hassali, Mohd. Baidi Bahari, Asrul Akmal
Shafie, in an Original Article titled “Generic medicine substitution
practices among community pharmacists: A nationwide study from Malaysia”
published in J. Public Health; studied the generic medicine substitution
practices among Malaysian community pharmacists. It was found there exist a
very high prevalence of generic substitution for the brand name medicine
requests. Pharmacists seldom consulted physicians when substituting generics
for brand name medicines and the high substitution rate of medicines were seen
for both acute and chronic diseases. Both, physicians and patients highly
accepted the substitution recommendation and this contributed to significant
reduction in patient’s medicines expenditure.
• Reeta Heikkilä, Pekka Mäntyselkä and Riitta Ahonen, in a
Research Article titled “Price, familiarity, and availability determine
the choice of drug - a population-based survey five years after generic
substitution was introduced in Finland” published in BMC Clinical
Pharmacology; found that Price, availability, and familiarity were the three
most important factors that influenced the choice of medicines. For people who
had refused Generic Substitution” (GS), the familiarity of the medicine
was the most important factor. For the subjects who had allowed GS and for
those who had both refused and allowedGS, price was the mostimportant factor.
• Susana Narciso, in her research paper “Retailing Policies for
Generic Medicines’ published in International Journal of Health Care
Finance and Economics; agrees that there is general disagreement about the way
generic medicines should be commercialized. She discusses two policies. In the
first policy scenario, pharmacies are allowed to substitute generic medicines
for branded ones, while in the second, substitution is forbidden. However, the
policy choice belongs to the government, which prefers to allow for
substitution more often than patients would like.
• Gill, Liz; Helkkula, Anu; Cobelli, Nicola; White, Lesley in their paper titled “How do customers and pharmacists experience generic substitution?” published in International Journal of Pharmaceutical and Healthcare Marketing; The paper explores the generic substitution experience of customers and pharmacists in a pharmacy practice setting. The findings show that customers, with poor awareness of generic prescription medicine when offered as a substitute, were likely to become confused and suspicious. Pharmacists related how they felt challenged by having to facilitate generic substitution by educating unaware customers. They also experienced frustration due to the mistrust and annoyance their customers displayed.
6. Results
Demographics of the purchasers of medicines (Table: 3)
At the end of the two day study, responses were obtained from 120 live
prescriptions. A total of 2 chemists and 6 Consulting Physicians (CP) were
tracked in this study. Two third (75%) of the purchase was made by female. The
age group of purchaser of medicine ranged from 16 years to 73 years, with
maximum from the 40 to 50 years age group (42/35%) followed by 30 to 40 years
group (27/22.5%) and the least purchaser group was from the over 60 years
group (3/2.5%).
As regards to the educational background of the purchasers, majority
(89/74.2%) were graduates and only 12/10% had attended school. The rest
19/15.8% were post graduates.
Income wise, over 54% (65) of the purchasers were having a monthly income of
above forty thousand, 31% (37) with income above twenty thousand and only 6%
(7) belonged to an income of less than ten thousand per month.
52.5% (63) of the purchasers were not employed and comprised of either house
wives or daily wagers and 6.6% (8) were retired people.
Predominantly, the purchase was made by relatives or others (97/81%) and
direct purchase of medicines by the patient himself/herself was only 19% (23).
Overall distribution of prescription prescribed and prescription substituted
(Table: 1) 120 actual prescriptions with a total of 513 requests for brand
name were recorded. Out of the 120 prescriptions surveyed, brand substitution
(one or more items substituted) was seen in 63 (52.5%) prescriptions. The
surveyed prescriptions revealed brand substitutions by dispensing chemists for
158 brands items (30.8%) out of a total of 513 originally prescribed brands.
The maximum number of brand items seen in a single prescription was 8 and the
minimum prescribed items was 3.
Brand name requests-Therapeutic class-wise (Table: 2)
As a therapeutic class, the maximum brand name requests (out of N=513) were
for Musculoskeletal/Fever (136/26.5%) followed by; Antibiotics for systemic
use (116/22.6%), GI Tract (68/13.3%), Respiratory system (67/13.1%) and
Nutritional Supplements (58/11.3%). The least brand name request was observed
in the therapeutic class ofCardiovascular(16/3.1%) and Anti diabetics
(12/2.3%)respectively.
Brand name requests-Sub-therapeutic class-wise (Table: 2)
As a sub-therapeutic class, the maximum brand name requests (out of N=513)
were for PPI and Multi-vitamins/Multiminerals equally at 7.6% (39), Cough &
Cold preparations, NSAIDs/Combinations and Penicillin Group/Combination
equally at 7% (36). The least request was observed for ACE
inhibitors/Combinations 0.2% (1), Other Cardiovasculars 0.2% (1), Beta
blockers/Combinations 0.4% (2), DPP4 Inhibitors 0.4% (2) and Insulins 0.4%
(2).
Branded generic substitution-Therapeutic class-wise (Table: 2)
As a therapeutic class, the highest branded generic substitution was seen in
Musculoskeletal/Fever 39 (24.7%) followed by; Antibiotics for systemic use 36
(22.8%), Nutritional supplements 27 (17.1%) and Respiratory system 23 (14.6%).
Antidiabetics 1 (0.6%), Cardiovascular 2 (1.3%) and Dermatologicals 8 (5.1%)
are the therapeutic class that are least substituted by branded generics.
Branded generic substitution-Sub-therapeutic class-wise (Table: 2)
In the sub-therapeutic class, the highest branded generic substitution was
seen in Paracetamol/Combinations 24 (15.2%) followed by;
Multi-vitamins/Multi-minerals 17 (10.8%), Cough & Cold Preparations 15 (9.5%)
and Penicillin group/Combination 14 (8.9%).
Branded generic substitution rate-Therapeutic class-wise (Table: 2)
The highest rate of substitution was seen in Nutritional supplements (46.6%)
followed by Dermatologicals (34.8%), Respiratory system (34.3) and Antibiotics
for systemic use (31.0%). The lowest rate of substitution was observed in
Antidiabetics (8.3%) and Cardiovasculars (12.5%).
Branded generic substitution rate-Sub-therapeutic class-wise (Table: 2)
The rate of substitution was maximum seen in Protein preparations (60%)
followed by Antacids, Topical Corticosteroids/Combinations and
Haematinics/Combinations each at (50%). The minimum rate of substitution is in
the class of DPP4 Inhibitors (2.5%), Macrolides (3.8%), Inhalants (16.7%) and
Muscle relaxants (16.7%).
Type of prescription substitution (Table: 4)
Total number of brand items substituted in the prescriptions is 158. The
prescription substitution was categorised in to three types, namely,
Prescription substituted by patients, Prescriptions substituted by chemists
and Prescription substituted due to non-availability ofthe prescribed brand.
Prescription substituted by Patients was 61 (38.6%), by Chemists 71 (44.9%)
and substitution due to Non-availability was 26 (16.5%).
The maximum number of prescriptions substituted by patients was observed in the therapeutic class of Antibiotics (14/8.9%) followed by Respiratory (13/8.2%) and Nutritional Supplements (12/7.6%).
Prescription substitution by chemists was seen highest in the therapeutic class of Musculoskeletal (24/15.2%) followed by Antibiotics (18/11.4%) andNutritional Supplements (10/6.3%).
Prescription due to non-availability was maximum in Musculoskeletal/Fever (6/3.8%) followed by Nutritional Supplements (5/3.2%) and Antibiotics (4/2.5%).
Demographic profile of purchasers and prescription substitution effected
(Table: 3)
Out of a total of 120 purchasers, 1/3rd was male and 2/3rd was female.
Prescription substitution was effected with 40% of male purchasers (12/30) and
56.7%of female purchasers (51/90).
Prescription substitution observed in the age group less than 20 years was the least at 37.5% (3/8) followed by 52.4% (22/42) belonging to the age group 21 to 40 years and the maximum substitution of 54.3% (38/70) was seen in the over 40 years age group.
Highest level of prescription substitution of 58.3% (7/12) was seen in people with educational background of attending only up to school level followed by graduates at 55% (49/89) and the substitution was the least in post graduates at 36.8% (7/9).
As regards to prescription substitution happening on account of income level, it was seen maximum 71.4% (5/7) with purchasers who has an income below Rs. 10,000 per month followed by 60.4% (29/48) in the slab of Rs. 10,000 to Rs. 40,000 and the lest substitution 44.6% (29/65) was seen with purchasers who had an income of over Rs. 40,000 per month.
Table: 1 Distribution of prescription prescribed and prescription substituted
|
Total number of prescriptions captured |
120 (100%) |
|
Total number of prescriptions in which substitutions occurred |
63 (52.5%) |
|
Total number of brand name requests |
513 (100%) |
|
Total number of substitutions occurred |
158 (30.8%) |
|
Max number of brands prescribed in a single prescription |
8 |
|
Min number of brands prescribed in a single prescription |
3 |
Table: 2 Therapeutic and sub-therapeutic group-wise brand name prescribed and substitution effected
|
|
N=513 Brand Name Prescribed No. of cases (%) |
N=158 Substitution No. of cases (%) / Substitution Rate (%) |
|
Antibiotics for systemic use |
116 (22.6) |
36 (22.8) / (31.0) |
|
Cephalosporin’s/Combinations |
32 (6.2) |
13 (8.2) / (40.6) |
|
Quinolones/Combinations |
19 (3.7) |
5 (3.2) / (26.3) |
|
Macrolides |
29 (5.7) |
4 (2.5) / (13.8) |
|
Penicillin group/Combinations |
36 (7.0) |
14 (8.9) / (38.9) |
|
Respiratory system |
67 (13.1) |
23 (14.6) / (34.3) |
|
Cough & Cold preparations |
36 (7.0) |
15 (9.5) / (41.7) |
|
Inhalants |
6 (1.2) |
1 (0.6) / (16.7) |
|
Antihistamines |
18 (3.5) |
5 (3.2) / (27.8) |
|
Others |
7 (1.4) |
2 (1.3) / (28.6) |
|
GI tract |
68 (13.3) |
19 (12.0) / (28.0) |
|
PPIs |
39 (7.6) |
9 (5.7) / (23.1) |
|
Antacids |
14 (2.7) |
7 (4.4) / (50.0) |
|
Antinauseants |
15 (2.9) |
3 (1.9) / (20.0) |
|
Musculoskeletal/Fever |
136 (26.5) |
39 (24.7) / (28.7) |
|
NSAIDs/Combinations |
36 (7.0) |
12 (7.6) / (33.3) |
|
Muscle relaxants |
18 (3.5) |
3 (1.9) / (16.7) |
|
Paracetamol/Combinations |
82 (16.0) |
24 (15.2) / (29.3) |
|
Dermatologicals |
23 (4.5) |
8 (5.1) / (34.8) |
|
Topical anti-infectives/Combinations |
8 (1.6) |
2 (1.3) / (25.0) |
|
Antifungals |
9 (1.8) |
3 (1.9) / (33.3) |
|
Topical corticosteroids/Combinations |
6 (1.2) |
3 (1.9) / (50.0) |
|
Nutritional supplements |
58 (11.3) |
27 (17.1) / (46.6) |
|
Multi vitamins-Multi minerals |
39 (7.6) |
17 (10.8) / (43.6) |
|
Protein preparations |
5 (1.0) |
3 (1.9) / (60.0) |
|
Haematinics/Tonics |
14 (2.7) |
7 (4.4) / (50.0) |
|
Antidiabetics |
12 (2.3) |
1 (0.6) / (8.3) |
|
Insulins |
2 (0.4) |
- |
|
OHAs |
8 (1.6) |
1 (0.6) / (12.5) |
|
DPP4 Inhibitors |
2 (0.4) |
- |
|
Cardivasculars |
16 (3.1) |
2 (1.3) / (12.5) |
|
Beta blockers/Combinations |
2 (0.4) |
- |
|
ACE inhibitors/Combinations |
1 (0.2) |
1 (0.6) / (100.0) |
|
CCB/Combinations |
3 (0.6) |
- |
|
ARB/Combinations |
4 (0.8) |
- |
|
Lipid lowering agents |
5 (1.0) |
1 (0.6) / (20.0) |
|
Others |
1 (0.2) |
- |
|
All others |
17 (3.3) |
3 (1.0) / (17.6) |
Table: 3 Demographics of the person who purchased the medicines from the chemist with the prescription given by the doctor/Prescription substitution effected
|
Gender Male Female |
30/12 90/51 |
Income (per month) < 10,000 10,000 – 20,000 20,000 – 30,000 30,000 – 40,000 40,000 – 50,000 > 50,000 |
7/5 11/8 16/8 21/13 35/15 30/14 |
|
Age Group (Years) |
|
Occupation |
|
|
< 20 |
8/3 |
Employed |
49/28 |
|
21 – 30 |
15/8 |
Unemployed |
63/34 |
|
31 – 40 |
27/14 |
(Housewife/Daily wages) |
|
|
41 – 50 |
42/23 |
Retired |
8/1 |
|
51 – 60 |
25/14 |
|
|
|
> 60 |
3/1 |
|
|
|
Education |
|
Purchaser |
|
|
Attended school |
12/7 |
Patient |
23/14 |
|
Graduate |
89/49 |
Relative |
97/49 |
|
Post graduate |
19/7 |
|
|
Table: 4 Type of prescription substitution at the chemist level
|
|
N=158 Generic Substitution No. of cases (%) |
|
Antibiotics for systemic use |
36 (100) |
|
Substitution asked by patient |
14 (38.9) |
|
Substitution done by chemist |
18 (50.0) |
|
Substitution due to non-availability |
4 (11.1) |
|
Respiratory system |
23 (100) |
|
Substitution asked by patient |
13 ((56.5) |
|
Substitution done by chemist |
8 (34.8) |
|
Substitution due to non-availability |
2 (8.7) |
|
GI tract |
19 (100) |
|
Substitution asked by patient |
9 (47.4) |
|
Substitution done by chemist |
8 (42.1) |
|
Substitution due to non-availability |
2 (10.5) |
|
Musculoskeletal/Fever |
39 (100) |
|
Substitution asked by patient |
9 (23.1) |
|
Substitution done by chemist |
24 (61.5) |
|
Substitution due to non-availability |
6 (15.4) |
|
Dermatologicals |
8 (100) |
|
Substitution asked by patient |
2 (25.0) |
|
Substitution done by chemist |
3 (37.5) |
|
Substitution due to non-availability |
3 (37.5) |
|
Nutritional supplements |
27 (100) |
|
Substitution asked by patient |
12 (44.5) |
|
Substitution done by chemist |
10 (37.0) |
|
Substitution due to non-availability |
5 (18.5) |
|
Antidiabetics |
1 (100) |
|
Substitution asked by patient |
- |
|
Substitution done by chemist |
- |
|
Substitution due to non-availability |
1 (100.0) |
|
Cardiovascular |
2 (100) |
|
Substitution asked by patient |
1 (50.0) |
|
Substitution done by chemist |
- |
|
Substitution due to non-availability |
1 (50.0) |
|
All others |
3 (100) |
|
Substitution asked by patient |
1 (33.3) |
|
Substitution done by chemist |
- |
|
Substitution due to non-availability |
2 (66.7) |
7.Discussion
Drug substitution by chemists is quite rampant in India and few studies have been carried out on this aspect in the past.
When prescription is written for branded product, the chemist must dispense that product only, unless they persuade the doctor to change the prescription. In such situations the chemists can substitute branded generic product for the brand prescribed by the doctor.
Substitution by branded generics is helpful to the patients to reduce their overall therapy cost while treating both acute and chronic ailments. However, such substitution can be potentially harmful when practised without the consent of the doctor and patients.
For pharma companies who spend considerable amount of money to promote their brand, such practices can erode their brand sales and thus, affect profitability. This pilot study has revealed that prescriptions are substituted by both the chemists and the patients. Substitution of prescribed brands by chemists may be due to non-availability of the brands in the chemists’ counters. This can be countered by pharma companies by efficiently managing the distribution channel.
Prescription substitutions can also happen if the chemists are commercially inclined to push more profitable branded generics. Pharma companies can meet this challenge either through bonus offers for the brands or alternatively by introducing low-price fighter brands. Substitution by patients on grounds of cost of therapy is also gaining, and this practice is seen cross all demographics. Owing to low penetration of medical insurance, the cost of medicines is not only pinching the low income but also the purchasers with higher income as observed in this study.
Pharma companies has to keep in mind this emerging trend in the population and should take necessary measures to provide value added services to the end-users (patients) to desensitise the premium price charged for their brands.
Interestingly, despite lack of pharmacy regulation in India, the prescription substitution with branded generics is considerably low compared to developed countries which have adopted generic substitution policy where the substitution rate is over 90%. One possible reason could be to counter the high cost of brands under patents. Also, major cost of medicines in developed country is reimbursed through medical insurance.
However, the findings of this pilot study points to brand substitution in one out of every two prescriptions i.e. 52.5% (one or more brands substituted) and total number of brand substitutions by the chemists was 158 items out of a total of 513 originally prescribed brands. These figures are considerably high and should be of concern to the pharma companies promoting their brands. In the absence of medical insurance coupled with rising cost of medicines, the prescription substitution rate is likely to gain momentum in the future.
Further, chemists substitute brands without informing the physicians. It is interesting to note that 38.6% of the substitutions were asked for by the patients against 44.9% substitutions done by the chemists on their own and substitution due to Non-availability was (16.5%). This shows both; chemists and patients are actively involved in prescription substitutions. Substitution was observed cross all therapeutic groups and sub-therapeutic groups and cross the demographics of the purchasers such as gender, age group, income and education without any exceptions.
From the chemists and patients point of view, there could be various reasons for prescription substitution. This study did not establish all possible reasons for the substitution except non-availability of the brand. The sample size of doctors,
chemists and number of live prescriptions studied were very few and therefore cannot be projected to the population. Also, the spread of samples selected was very limited.
8. Conclusion
Prevalence of prescription substitution is fairly high at the retail level and involved most of the therapeutic and sub-therapeutic groups.
Purchasers belonging to both higher income and lower income engaged in prescription substitution. Also, prescription substitution was observed in all age groups of purchasers and in both genders. People who are educated and not so educated also did prescription substitution. Most of the purchasers of medicines were females and most of the actual buyers were relatives of the patients.
Both, the identified chemists and randomly selected patients, actively practised generic substitution for prescribed brands. Patients too solicited for brand substitution possibly to reduce the burden of therapy cost.
Substitution due to non-availability was less compared to substitution done by chemists and patients. However, neither the chemists nor the patients took consent from the prescribers before substitution of brands. The chemists are benefitted by generic substitution and consider substitution by branded generics is an acceptable practice. The patients too, possibly, wanted substitution to significantly reduce their cost of medicines.
9. References
Authored by
Hari Kumar Iyer,
SVKM’s NMIMS, School of Business
Dr. Nilesh Berad, MET, Nashik
©Mumbai Educational Trust, All rights reserved | Last Modified Date: Saturday, April 20th, 2024