Substitution, generic

In many circumstances, generic substitution is a safe and effective cost-saving tool, but the clinician should be aware of potential problems and, in the event of an unexpected reaction, should ask the patient if the medication has changed in appearance. A change in size, shape, or color, for example, should alert the clinician to a probable change in generic formulation. 

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Cost-minimization analysis concerns a direct comparison only between treatments that produce identical outcomes. However, other than in the case of generic substitution,... 

There is no evidence that one LT4 product is better than another. However, given the likelihood that these products do have different bioavailabilities, patients should be maintained on the same LT4 product. Given the generic substitution regulations of most states, this is best accomplished by prescribing a brand-name product. The prescriber should not allow substitution in the way mandated by state regulations. 

France benefits from new generic substitution rules, Pharm. J., 264, 427 (2000). 

JM Ganther, DH Kreling. The effect of implementing a maximum allowable cost generic substitution plan on... 

The growth of generic prescribing and generic substitution will clearly increase the role and responsibilities of pharmacists in drug product selection. This movement will also stimulate in many regions of the world further debate about how bioequivalence should be quantified and when in vitro methods may, in some... 

Explicit support for generics Substitution by pharmacists Remuneration system for pharmacies Economic evaluation Reference pricing... 

Keating, E.J., "Maximizing Generic Substitution in Managed Care,". Managed Care Pharm., 4, 557-563 (1998). 

In the United Kingdom, generic substitution was raised as a means of reducing the NHS medicines bill in the Greenfield Report of 1983, but was not implemented. 

Generic substitution has however been implemented by a number of reimbursement authorities, both insurance based schemes as in the United States and nationally run health care schemes, for example, Sweden (introduced October 2002) and Finland (introduced 1st April 2003) both countries health care schemes claim very considerable savings of the order of 5% of national expenditure on medicines. Sweden is considering extending the scheme to lead to compulsory generic prescribing. 

More stringent forms of the copayment approach are maximum allowable cost programs. Those programs require that the patient pay the full difference between the branded prescription and the normal prescription copayment. In the extreme case, mandatory generic substitution programs require that generics be dispensed or the patient receive no reimbursement at all. 

Masson, A., and R. Steiner. 1985. Generic Substitution and Prescription Drug Prices Economic Effects of State Drug Product Selection Laws. Staff Report of the Bureau of Economics, FTC, Washington, DC, October. 

The cost of generic substitutes is usually considerably less than that for the trade name psychotropic drugs, but issues of bioequivalence must also be considered (see the section The Four Primary Pharmacokinetic Phases in Chapter 3). Using the fewest tablets to achieve a targeted dose level is always less expensive. Unit dose systems, sustained release preparations, and concentrate forms all increase the cost ( 26). 

During a substitution reaction, two reactants exchange parts to form a new substance. If the groups are written as X and Y, a generic substitution reaction looks like this ... 

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