The economic implications of generic substitution of antiepileptic drugs: a review of recent evidence

Duh, Mei Sheng; Cahill, Kévin; Paradis, Pierre Emmanuel; Crémieux, Pierre‐Yves; Greenberg, Paul E.

doi:10.1517/14656560903140525

Cited by 23 publications

(19 citation statements)

References 39 publications

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“…The actual savings generated by a compulsory switch from Lamictal to generic lamotrigine in Ontario, Canada, were much smaller than expected (Duh et al, 2007). In a recent review, Duh et al (2009) concluded that overall health care costs were higher during periods of generic anticonvulsants use than during periods of brand name use in Canada and the USA. Layton and Barbeau (2004) calculated the potential cost savings of switching patients from Clozaril to generic clozapine in Canada based on the incidence of relapses associated with the switch.…”

Section: Discussionmentioning

confidence: 94%

Loss of response after switching from brand name to generic formulations: three cases and a discussion of key clinical considerations when switching

Margolese¹,

Wolf

Desmarais³

2010

International Clinical Psychopharmacology

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Generic formulations of medications are marketed as therapeutically equivalent and less expensive than branded ones. Multiple studies and case reports have described relapses and worsening clinical outcome in patients after a switch from a brand name to a generic medication. Recent studies have shown that generics do not always lead to the expected costs savings, reducing the impetus to proceed with compulsory generic switching. We report on three patients who experienced clinical deterioration after commencing the generic formulation of their previous brand name psychotropic medication. We discuss key clinical differences between original and generic formulations of the same medication. The use of bioequivalence as an indicator of therapeutic and clinical equivalence, the lack of appropriate studies comparing generic and brand name medications and differences in excipients are some of the factors that could explain variation in clinical response between generic and brand name medications. Generic switching should be decided on a case-by-case basis with disclosure of potential consequences to the patient.

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Section: Discussionmentioning

confidence: 94%

Loss of response after switching from brand name to generic formulations: three cases and a discussion of key clinical considerations when switching

Margolese¹,

Wolf

Desmarais³

2010

International Clinical Psychopharmacology

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“…Physicians and pharmacists agree that sometimes, there could a genuine reason to use branded medications but this should be as situations demand. 25,26 in their report agreed that the use of generic medications does not always guarantee cost savings for certain diseases, even though clinical outcome might be similar to their branded counterparts. On the other hand, community Pharmacies have been known to consider gain over affordability when dispensing medications to patients.…”

Section: Discussionmentioning

confidence: 99%

Extents of Generic Prescribing in Hospitals and Community Pharmacies for Diabetic and Hypertensive Outpatients in Eastern Region of Saudi Arabia

Emeka¹,

Ahmed²

2017

JYP

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Objective: As population increase, Healthcare resources are stretched and the need to reduce prescription drug spending becomes obvious. The aim of this study was to evaluate the levels of generic prescribing in place of their branded counterparts among type 2 diabetic and hypertensive outpatients in Eastern region of Saudi Arabia. Method: A cross section of 13 Hospitals and 17 Community Pharmacies located in Al Ahsa, Dhahran, Khobar and Dammam (both Government and private) were visited. Out of which 58 Physicians and Pharmacists were interviewed with a structured questionnaire. Reasons for prescribing and serving either generic or branded were also ascertained. Patients' prescriptions were also examined at the various hospital and community pharmacies. Our focus was on prescription drugs for type 2 diabetic and hypertensive patients only and the study lasted for 6 months. Results: Findings revealed that only 26.9% generic medications were prescribed for both type 2 diabetic and hypertensive patients in the 13 hospitals sampled. It was also observed that while Government hospital prescribed 33.3% generics, private hospitals had 28.6% for same patient category. In the Community Pharmacies, only 23.5% generic were served for diabetics and 11.8% for hypertensive patients. Overall Hospitals branded prescription were 73.1% whereas in community Pharmacies, they represented 82.4% served medications. Conclusion: Levels of generic medication usage appeared to be significantly low. Majority of the Physicians and Pharmacists were of the belief that branded medications give better outcome to patients and this attitude could potentially render Government policies on the use of generic medication ineffective.

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“…have concluded that there really does not seem to be any conclusive association between generic substitution and either loss of seizure control or new, treatment-emergent adverse effects (2), although there clearly is a suggestion that when generic substitution occurs, expenditures of resources goes up (3,4).…”

Section: Generic Antiepileptic Drugs: How Good Is Close Enough?mentioning

confidence: 99%

Generic Antiepileptic Drugs: How Good is Close Enough?

Gidal¹

2012

Epilepsy Curr

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CommentaryIt used to be that cost was only one of the many factors that played into the therapeutic decision-making process. That was then, and this is now. Now, for many individuals, cost is the primary factor governing choice of drug treatment. There are many reasons why a patient might fail to achieve optimal seizure control, including such things as drug interactions, treatment-emergent adverse effects, medication nonadherence, and, of course, lack of drug efficacy. Many of these factors we can modify or control. Clinical experience has taught that, for many patients, optimization of treatment requires careful fine-tuning of medication, and that many antiepileptic drugs (AEDs), especially the poorly soluble ones, will display a certain amount of pharmacokinetic variability between patients. The underlying assumption is made, however, that for a given product, pharmacokinetic performance will remain relatively constant between one dose to another. This very fundamental assumption becomes a bit more tenuous, however, when patients frequently switch between different formulations of a given drug. At least, that is the concern. Skeptics will say that this is an unfounded concern and that the guidelines in place by the regulatory bodies should assure us and our patients.

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The economic implications of generic substitution of antiepileptic drugs: a review of recent evidence

Cited by 23 publications

References 39 publications

Loss of response after switching from brand name to generic formulations: three cases and a discussion of key clinical considerations when switching

Loss of response after switching from brand name to generic formulations: three cases and a discussion of key clinical considerations when switching

Extents of Generic Prescribing in Hospitals and Community Pharmacies for Diabetic and Hypertensive Outpatients in Eastern Region of Saudi Arabia

Generic Antiepileptic Drugs: How Good is Close Enough?

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