Generic substitution, replacement and substitution of drugs: contemporary extent

Overview

When dispensing the medication, the dispensing chemist should inform the patient about the possible alternatives to the medicament dispensed and, with his consent, he can replace it with another preparation of identical properties (a generic drug, a bioequivalent preparation) in case it is not forbidden by the physician. A replacement of the prescribed drug is performed in the case that the required preparation is not in stock and its immediate dispensation is necessary. The present paper compares the prices of generics and original preparations and the extent of replacements and substitutions. The method employed was an analysis of data about dispensation in pharmacies. Of 61 generics under study, 10 preparations had a higher price than the original ones. Replacements and substitutions were monitored for a period of 1 year in preparations containing 14 selected active ingredients. Instead of the prescribed preparations containing omeprazole and ranitidine (26 HVLP), generics were dispensed in 31.0 %, i.e. 157 cases (113 of it were substitutions). In the groups of drugs used for high blood pressure therapy (9 active ingredients, 63 kinds of mass-produced preparations), generics were dispensed in 14.5 %, i.e. 120 cases (112 cases of it were substitutions). Instead of the prescribed preparations containing simvastatin, atorvastatin and fenofibrate (42 mass-produced preparations), generics were dispensed in 17.5 %, i.e. 82 cases (67 cases of it were substitutions). The found percentage of realized generic substitutions is low (6.2 %–28.0% according to the type of the active ingredient) when calculated to the total amount of the performed replacements and substitutions.

Key words:
substitution – replacement – generic substitution – generics – ATC group