Patients’ beliefs about generic medicines in Malaysia
Background: Acceptance of generic medicines by patients is an essential factor given that they are the end users of these medicines. In fact, adequate knowledge and positive perceptions are prerequisite to patients’ acceptance and use of generic medicines.
Objective: To assess the current belief and views of patients about generic medicines in Malaysia.
Method: This was a self-administered questionnaire-based study. The study was conducted with patients visiting outpatient pharmacy department at a tertiary care hospital in Malaysia. The Malaysian version of Generic Medicines Scale (GMS) was used. The GMS consists of two subscales: efficacy and similarity of generic medicines to original brand medicines. The efficacy subscale consists of 10 items while the similarity subscale consists of 6 items. The responses to the items were framed as a five-point Likert scale (1=strongly disagree to 5=strongly agree).
Results: A total of 202 out of 300 patients participated in the study, giving a response rate of 67.3%. In this study, only 49% of them (n=99) knew the term ‘generic medicine’. Moreover, only 53.5% of the respondents (n=108) believed that the efficacy of generic medicines was the same as original brand medicines. In terms of quality, only 44% of the respondents (n=89) disagreed that generic medicines were of a lower quality. About one third (n=65, 32.2%) believed that generic medicines were cheaper because they were less efficacious. In terms of side effects, 44.5% of the respondents (n=90) believed that generic medicines had the same side effect profile as original brand medicines.
Conclusions: The study finding showed that almost half of the respondents had negative belief in generic medicines. Similarly, many patients were not aware of the similarities and differences between generic and original brand medicines. Therefore, there is a need to provide patients with adequate information about generic medicines.
2. Steinwachs DM. Pharmacy benefit plans and prescription drug spending. JAMA. 2002;288(14):1773-1774.
3. Malaysian-German Chamber of Commerce and Industry. “Market Watch 2012” The healthcare sector in Malaysia. 2011. Available from: http://www.malaysia.ahk.de/fileadmin/ahk_malaysia/Market_reports/The_Healthcare_Sector_in_Malaysia.pdf (accessed 24th April, 2014).
4. Hassali MA, Alrasheedy AA, McLachlan A, Nguyen TA, Al-Tamimi SK, Ibrahim MIM, Aljadhey H. The experiences of implementing generic medicines policy in eight countries: A review and recommendations for a successful promotion of generic medicines use. Saudi Pharm J. 2014. (In press). doi:10.1016/j.jsps.2013.12.017
5. King DR, Kanavos P. Encouraging the use of generic medicines: implications for transition economies. Croat Med J. 2002;43(4):462-469.
6. Kanavos P. Do generics offer significant savings to the UK National Health Service? Curr Med Res Opin. 2007;23(1):105-116.
7. Karim SA, Pillai G, Ziqubu-Page T, Cassimjee M, Morar M. Potential savings from generic prescribing and generic substitution in South Africa. Health Policy Plan. 1996;11(2):198-205.
8. Haas JS, Phillips KA, Gerstenberger EP, Seger AC. Potential savings from substituting generic drugs for brand-name drugs: medical expenditure panel survey, 1997–2000. Ann Intern Med. 2005;142(11):891-897.
9. Shafie AA, Hassali MA. Price comparison between innovator and generic medicines sold by community pharmacies in the state of Penang, Malaysia. J Generic Med. 2008;6(1):35-42.
10. Martin Y. SCRIP's Complete Guide to the World Generic Drugs Market. Richmond, UK: PJB; 1999.
11. European Generic Medicines Association. EGA fact sheet on generic medicines: Frequently Asked Questions (FAQs). Available from: http://www.egagenerics.com/images/factsheet/EGA_factsheet_06.pdf (accessed 23rd June 23, 2013).
12. Simoens S, Coaster SD. Sustaining generic medicines markets in Europe. Research Centre for Pharmaceutical Care and Pharmaco-economics, Katholieke Universiteit Leuven. 2006. Available from: http://126.96.36.199/images/publikacje/7_pl.pdf (accessed 30th January, 2014).
13. Godman B, Malmström R, Bennie M, Sakshaug S, Burkhardt T, Campbell S, Garuoliene K, Schwabe U, Vončina L, Gustafsson LL. Prescribing restrictions–a necessary strategy among some European countries to enhance future prescribing efficiency? Rev Health Care. 2011;3(1):5-16.
14. Godman B, Shrank W, Wettermark B, Andersen M, Bishop I, Burkhardt T, Garuolienè K, Kalaba M, Laius O, Joppi R. Use of generics - a critical cost containment measure for all healthcare professionals in Europe? Pharmaceuticals. 2010;3(8):2470-2494. doi:10.3390/ph3082470
15. Godman B, Wettermark B, Bishop I, Burkhardt T, Fürst J, Garuoliene K, Laius L, Martikainen J, Semet C, Teixeira I. European payer initiatives to reduce prescribing costs through use of generics. GaBI J. 2012;1(1):22-27.
16. Ministry of Health Malaysia. Malaysian National Medicines Policy. 2007. Available from: http://www.pharmacy.gov.my/aeimages//File/MNMP_DUNAS.pdf (accessed 24th April, 2014).
17. Ministry of Health Malaysia. Malaysian National Medicines Policy. 2012. Available from: http://www.pharmacy.gov.my/v2/sites/default/files/document-upload/buku-dunas.pdf (accessed 24th April, 2014).
18. Dylst P, Vulto A, Simoens S. Demand-side policies to encourage the use of generic medicines: an overview. Expert Rev Pharmacoecon Outcomes Res. 2013;13(1):59-72. doi: 10.1586/erp.12.83
19. Alrasheedy AA, Hassali MA, Stewart K, Kong DC, Aljadhey H, Mohamed Ibrahim M, Al-Tamimi SK. Patient knowledge, perceptions, and acceptance of generic medicines: a comprehensive review of the current literature. Patient Intell. 2014;6:1-29. doi: 10.2147/PI.S46737
20. Hassali MA, Kong DCM, Stewart K. Generic medicines: perceptions of consumers in Melbourne, Australia. Int J Pharm Pract. 2005;13(4):257-264. doi: 10.1211/ijpp.13.4.0004
21. Babar ZUD, Stewart J, Reddy S, Alzaher W, Vareed P, Yacoub N, Dhroptee B, Rew A. An evaluation of consumers’ knowledge, perceptions and attitudes regarding generic medicines in Auckland. Pharm World Sci. 2010;32(4):440-448. doi: 10.1007/s11096-010-9402-0
22. Hassali MAA, Shafie AA, Jamshed S, Ibrahim MIM, Awaisu A. Consumers' views on generic medicines: a review of the literature. Int J Pharm Pract. 2009;17(2):79-88.
23. Thomas R, Vitry A. Consumers’ perception of generic medicines in community pharmacies in Malaysia. South Med Rev. 2009;2(2):20-23.
24. Al-Gedadi NA, Hassali MA, Shafie AA. A pilot survey on perceptions and knowledge of generic medicines among consumers in Penang, Malaysia. Pharm Pract (Granada). 2008;6(2):93-97.
25. Wong ZY, Hassali MA, Alrasheedy AA, Saleem F, Yahaya AHM, Aljadhey H. Malaysian generic pharmaceutical industries: Perspectives from healthcare stakeholders. J Pharm Health Serv Res. 2014. (In Press). doi: 10.1111/jphs.12072
26. Kumar R, Hassali MAA, Kaur N, Muhamad Ali SK Abdul Kader. Perceptions of physicians from private medical centres in Malaysia about generic medicine usage: a qualitative study. GaBI J. 2014;3(2):63-70.
27. Pharmaceutical Association of Malaysia. Government hospitals. 2014. Available from: http://www.phama.org.my/index.cfm?&menuid=34 (accessed 14th January, 2014).
28. Israel GD. Determining sample size. University of Florida Cooperative Extension Service, Institute of Food and Agriculture Sciences, EDIS; 1992.
29. Figueiras MJ, Alves NC, Marcelino D, Cortes MA, Weinman J, Horne R. Assessing lay beliefs about generic medicines: development of the Generic Medicines Scale. Psychol Health Med. 2009;14(3):311-321. doi: 10.1080/13548500802613043
30. Wong ZY, Hassali MA, Saleem F, Yahaya AHM. Translation and validation of the Malaysian version of Generic Medicine Scale (GMS). J Med Market. 2014;14(1)32-40. doi: 10.1177/1745790414540928
31. Pallant J. SPSS survival manual: a step by step guide to data analysis using SPSS for Windows (Version 12). Australia: Allen & Unwin; 2005.
32. Field A. Discovering statistics using SPSS. Thousand Oaks, CA: Sage; 2009.
33. Jaafar S, Noh KM, Muttalib KA, Othman NH, Healy J, Maskon K, Abdullah AR, Zainuddin J, Bakar AA, Rahman SSA, Ismail F, Yuen CY, Baba N, Said ZM. Malaysia health system review. Health Syst Transit. 2013; 3(1):103.
34. Alrasheedy AA, Hassali MA, Aljadhey H, Ibrahim MIM, Al-Tamimi SK. Is there a need for a formulary of clinically interchangeable medicines to guide generic substitution in Saudi Arabia? J Young Pharm. 2013;5(2):73-5. doi: 10.1016/j.jyp.2013.06.006
35. Gossell-Williams M, Harriott K. Generic substitution in Jamaica: challenges to improving effectiveness. WHO Drug Information. 2007;21(4):294-299.
36. Al Ameri MN, Whittaker C, Tucker A, Yaqoob M, Johnston A. A survey to determine the views of renal transplant patients on generic substitution in the UK. Transpl Int. 2011;24(8):770-779. doi: 10.1111/j.1432-2277.2011.01268.x
37. Kobayashi E, Karigome H, Sakurada T, Satoh N, Ueda S. Patients’ attitudes towards generic drug substitution in Japan. Health Policy. 2011;99(1):60-65. doi: 10.1016/j.healthpol.2010.07.006
38. Shrank WH, Cadarette SM, Cox E, Fischer MA, Mehta J, Brookhart AM, Avorn J, Choudhry NK. Is there a relationship between patient beliefs or communication about generic drugs and medication utilization? Med Care. 2009;47(3):319-325. doi: 10.1097/MLR.0b013e31818af850
39. Hassali MA, Awaisu A, Shafie AA, Saeed MS. Professional training and roles of community pharmacists in Malaysia: views from general medical practitioners. Malays Fam Physician 2009;4(2-3):71-76.
40. Pharmaceutical Services Division. Poison Act 1952. 2013. Available from: http://www.pharmacy.gov.my/v2/sites/default/files/document-upload/poisons-act-1952-act-366.pdf (accessed 23th October, 2013).
41. Himmel W, Simmenroth-Nayda A, Niebling W, Ledig T, Jansen R-D, Kochen M, Gleiter C, Hummers-Pradier E. What do primary care patients think about generic drugs? Int J Clin Pharmacol Ther. 2005;43(10):472-479.
42. Losifescu A, Halm EA, McGinn T, Siu AL, Federman AD. Beliefs about generic drugs among elderly adults in hospital-based primary care practices. Patient Educ Couns. 2008;73(2):377-83. doi: 10.1016/j.pec.2008.07.012
43. Håkonsen H, Toverud EL. A review of patient perspectives on generics substitution: what are the challenges for optimal drug use. GaBi J. 2012;1(1):28-32.
44. Federman AD, Halm EA, Siu AL. Use of generic cardiovascular medications by elderly Medicare beneficiaries receiving generalist or cardiologist care. Med Care. 2007;45(2):109-115.
45. Heikkilä R, Mäntyselkä P, Hartikainen-Herranen K, Ahonen R. Customers' and physicians' opinions of and experiences with generic substitution during the first year in Finland. Health Policy. 2007;82(3):366-374.
46. Quintal C, Mendes P. Underuse of generic medicine in Portugal: an empirical study on the perceptions and attitudes of patients and pharmacists. Health Policy. 2012;104(1):61-8. doi: 10.1016/j.healthpol.2011.10.001
47. Shrank WH, Cox ER, Fischer MA, Mehta J, Choudhry NK. Patients' Perceptions of Generic Medications. Health Aff (Millwood). 2009;28(2):546-56. doi: 10.1377/hlthaff.28.2.546
48. Sewell K, Andreae S, Luke E, Safford MM. Perceptions of and barriers to use of generic medications in a rural African American population, Alabama. Prev Chronic Dis. 2012;9:E142. doi: 10.5888/pcd9.120010
49. Ngo SN, Stupans I, McKinnon RA. Generic substitution in the treatment of epilepsy: Patient attitudes and perceptions. Epilepsy Behav. 2013;26(1):64-66. doi: 10.1016/j.yebeh.2012.10.032.
50. Al Ameri M, Mohamed W, Makramalla E, Shalhoub B, Tucker A, Johnston A. Renal patients’ views on generic prescribing and substitution: example from the United Arab Emirates. East Mediterr Health J. 2013;19(4):373-381.
51. Sicras-Mainar A, Navarro-Artieda R. Physicians' and patients' opinions on the use of generic drugs. J Pharmacol Pharmacother. 2012;3(3):268-270. doi: 10.4103/0976-500X.99438
52. Lebanova H, Manolov D, Getov I. Patient's attitude about generics-Bulgarian perspective. Marmara Pharm J. 2012;16:36-40.
53. Figueiras MJ, Marcelino D, Cortes MA. People’s views on the level of agreement of generic medicines for different illnesses. Pharm World Sci. 2008;30(5):590-594. doi: 10.1007/s11096-008-9247-y
54. Gaither CA, Kirking DM, Ascione FJ, Welage LS. Consumers' views on generic medications. J Am Pharm Assoc. 2001;41(5):729-736.
55. Kaplan WA, Ritz LS, Vitello M, Wirtz VJ. Policies to promote use of generic medicines in low and middle income countries: a review of published literature, 2000-2010. Health Policy. 2012;106(3):211-224. doi: 10.1016/j.healthpol.2012.04.015
56. Hassali MA, Yuen KH, Ibrahim MIM, Wong JW, Ng BH, San Ho DS. Malaysian pharmaceutical industry: opportunities and challenges. J Generic Med. 2009;6(3):246-252.
57. Ministry of Health Malaysia. Malaysian guidelines for the conduct of bioavailability and bioequivalence studies. 2000. Available from: http://portal.bpfk.gov.my/index.cfm?&menuid=67&parentid=82&highlightid=78 (accessed 8th November, 2012).
58. Sharrad AK, Hassali MA. Consumer perception on generic medicines in Basrah, Iraq: Preliminary findings from a qualitative study. Res Social Adm Pharm. 2011;7(1):108-112. doi: 10.1016/j.sapharm.2009.12.003
59. Toverud EL, Røise AK, Hogstad G, Wabø I. Norwegian patients on generic antihypertensive drugs: a qualitative study of their own experiences. Eur J Clin Pharmacol. 2011;67(1):33-38. doi: 10.1007/s00228-010-0935-x
60. Simoens S, Coster SD. Sustaining generic medicines markets in Europe. J Generic Med. 2006;3(4):257-268. doi: 10.1057/palgrave.jgm.4940128
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.