South African medical doctors who insist on prescribing expensive brand-name medication when there are much cheaper generics available on the market are costing the country about R4 billion per year.
The finding from Mediscore data was is reiterated by Erik Roos, CEO of Pharma Dynamics – one of the leading generic medicine providers in the country.
“In a country such as ours, where access to affordable medicine is essential, healthcare practitioners could make an enormous difference if generic medicine is prescribed more diligently as it is a high value care way to improve patient health, whilst keeping costs in check,” said Roos.
The latest Mediscor data states that about one in five prescriptions for medical aid patients in the past year were for branded medication where generic equivalents were available.
Roos estimates that for patients with hypertension (high blood pressure) alone, substituting brand-name prescription medication for generics, would save millions. He added that “Generic hypertension medication is on average 44% cheaper than brand name medication, while a further 79% can be shaven off the price of brand name antidepressants if a generic alternative is used. Failing to substitute with a generic, means that many patients are paying over R350 for a product that could be costing them in the region of R75.”
Roos adds that pharmacists are obligated by law to offer patients a generic alternative, if the prescribed medication is substitutable.
The majority of peer-reviewed studies found that generic equivalents produced similar clinical outcomes when compared to their brand-name counterparts, but despite this some patients still express concern that generic medications are less effective.
In response, Roos cites a meta-analysis of 47 studies which compared the effectiveness of generic and brand-name medicines in nine classes of cardiovascular medications, which found no evidence of superiority of brand-name medication.
“Generic medicines are defined as products that are pharmaceutically equivalent to originators, which indicates that they contain the same amount of the active pharmaceutical ingredient (API). A generic version must also meet the exact same standards for effectiveness, safety and quality.
“The reason generic manufacturers can sell medication at a lower cost is not because it is of inferior quality, but because of the increased competition among generic manufacturers, who don’t have to go through the expensive research and development phase that brand companies have already gone through,” remarks Roos.
He goes on to explain that in order to change doctors’ prescription behaviour a lot more still needs to be done to ensure that healthcare practitioners are better informed about generics.
“Increasing the use of quality-assured generic medicine plays a key role in sustaining SA’s healthcare system and ultimately leads to improved access to essential treatments – a vision that the National Department of Health advocates. Doctors play a critical role in realising this ideal. By adopting a more generic-prescription-based model, healthcare practitioners could see medicine expenditure drop significantly, whilst providing patients with effective and affordable medication. It is estimated that every 1% increase in generic usage equates to a saving of R270 million.
“Another stumbling block could be patients that perceive lower-cost generics as inferior and may as a result insist on having doctors prescribe the more expensive brand-name product, therefore more awareness also needs to be created among consumers.
“In other cases, doctors may still be referring to medication by their original name, even long after generic versions have already become available, which could result in them inadvertently prescribing more expensive medications,” remarks Roos.
He says another factor doctors should consider is a patient’s long-term adherence to essential treatments.
“This could be significantly enhanced when a generic is prescribed, since brand-name medicines are likely to go uncollected, because of its high price tag. The price differential between originators and generics is now as much as 80%.”
Generic medicines now account for roughly 56% of medicines dispensed in the private sector, yet they only amount to 40% of the more than R22-bn South Africans spent on medicines last year. Elsewhere in the world, generic usage stands at 80%.