Discussing Brand Versus Generic Medications

Seema Ledan, PharmD


US Pharmacist. 2020;45(6):25-30. 

In This Article

Possible Barriers to Generic Prescribing and Ways to Overcome

Surveys and studies have been conducted throughout the years to analyze the barriers in generic usage or increase in switchbacks from generic to brand. Table 1 provides a list of possible barriers to generic prescribing and dispensing.[10–15]

A survey conducted in epileptic patients and their concerns of generic substitutions concluded that patients believed that changes should only be determined by the provider or patient. These concerns stemmed from providers' concerns of breakthrough seizure when switching or increased risk of side effects and from patients' concerns that generics may not provide equivalent efficacy or tolerability.[16] However, it is also been shown that having a relationship with one's pharmacist and making provider and patients aware of manufacturer changes may help improve generic usage in epileptic patients.[17]

In addition, some clinicians and scientists have expressed concerns about the FDA's bioequivalence approval. However, the Therapeutic Inequivalence Action Coordinating Committee, a postmarketing review group of the FDA, identifies and evaluates reports of therapeutic failures to determine if removal of inequivalent products is needed.[9] In addition, studies have concluded that the bioequivalence testing required by the FDA is robust and helps support the approval that brand and generics are therapeutically equivalent.[9]

Studies have reviewed switchback rates or the amount of times that patients switch back to branded drugs from generics despite a cost differential. Studies reviewing authorized generics and generics showed a lower rate of brand switchbacks due to interventions to improve communication and education on the equivalency of generics and brand-name products.[11,12] In addition, similarities in appearance also prevented brand switchbacks.[11]

Due to recent recalls on generic products, patients may also be apprehensive to switch to generics as they may not be produced in the U.S., believing that medications manufactured outside of the U.S. are not safe, despite FDA approval. Proper education on the details of recalls are effective to encourage adherence to medications.[14]

Despite the availability of a generic drug, the use of a brand-name product may be clinically appropriate in select situations. For example, previous patients taking epileptic medications who experienced an increase in seizure frequency with a generic switch may be appropriate for a change to a brand-name medication for seizure control.[15]

With the various barriers discussed above, multiple studies have shown that promoting educational interventions for patients and providers may help increase confidence in generic use.[13] In addition, educating on generic use may help improve quality of care and adherence to medications. The 2019 AAM report analyzed the abandonment rates for medications, examining the rate at which patients may not take or pick up their medications despite requesting the prescription. The report concludes that new patient abandonment rates are 266% higher for brand-name drugs when compared with generic drugs.[5] Copayments played a significant role in this abandonment rate; 90% of generic copays were under $20 compared with the 39% of brand medications.[5]