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The Malaysian pharmacists' have lack of information and/or trust in the generic manufacturing and/or approval system in Malaysia. This issue should be addressed by pharmacy educators and relevant government agencies.

Aims This study aims to assess generic medicine substitution practices among Malaysian community pharmacists. Method A cross-sectional nationwide descriptive study using a specific mailing data collection form was conducted from May 2007 through December 2007. A sample of 1,419 community pharmacies was involved in this study. Data were collected across the brand name medicine requests encountered on 14 working days and for which an equivalent generic product was available. Pharmacists' generic substitution rate, physicians' and patients' acceptance of substitution and cost saving achieved from substitution were assessed. Results Responses were received from 157 pharmacies (response rate 11.1%). The pharmacists recommended generic substitution for 84.7% (1,538/1,815) of the brand name medicine requests. While suggesting substitution, the pharmacists voluntarily consulted the physicians for 13.1% (91/695) of the recommendations which involved prescription orders. The majority of the physicians (87.9%) when consulted by the pharmacists accepted the recommendation for substitution. Meanwhile, 88.9% (1,368/1,538) of the pharmacists' substitution suggestions were accepted by the patients. The overall patients' expenditure on medicines was reduced by a total of 57.4% (Malaysian ringgit 27,266.30 or US $7,369.30; US $1.00 = Malaysian ringgit 3.70) through acceptance of substitution. Conclusion The Malaysian community pharmacists actively recommended generic substitution for brand name medicine requests which they encountered. Both the physicians and patients highly accepted the substitution recommendation and this contributed to significant reduction in patients' medicines expenditure.