Global Insight Perspective | |
Significance | A survey of 200 pharmacists on 21-22 April has revealed that the majority have, on some occasions, switched back to original brands after having previously substituted them with generics. |
Implications | The switch back to original brands is being driven by patients, who feel that generics are less effective, cause adverse reactions, or make them feel uncomfortable. |
Outlook | The survey represents more bad news for the government, given that it suggests that generic substitution rates may already have peaked. This is despite the fact that substitution levels still fall far short of original government targets. |
The survey, which was reported in Pharma Japan, was conducted via the Internet on 21-22 April, and was based on replies from 200 pharmacists. Based on the results of survey, Nextit compiled a list of the products that have been switched back from generics most often. The list incorporated a number of products from Daiichi-Sankyo (Japan), including its cholesterol-lowering statin Mevalotin (pravastatin), its non-steroidal anti-inflammatory drug (NSAID) Loxonin (loxoprofen), and its hypertension drug Adalat (nifedipine). Other products that featured on the list were Astellas's (Japan) H2-antagonist Gaster (famotidine) and Pfizer's (U.S.) hypnotic agent Halcion (triazolam).
In most cases, pharmacists switched back to the branded version of the drugs at the request of patients, who complained that the generic versions were less effective, caused adverse reactions, or that they were simply "uncomfortable" with generics.
Pharmacists Particularly Favoured Norvasc over Generic Alternatives
The survey also asked respondents to name the brand (or brands) that they would continue to prescribe despite the availability of generic alternatives. By far the most popular response was Pfizer's (U.S.) hypertension drug Norvasc (amlodipine), which was chosen by 16.5% of respondents. Other popular brands included Loxonin (7.5% of respondents), Adalat (7.5%), Halcion (7.0%), Abbott's (U.S.) asthma treatment Hokunalin (tulobuterol; 6.5%), and Novartis's (Switzerland) immunosuppressant Neoral (ciclosporin; 6.5%).
Respondents were also asked to identify the therapeutic category (or categories) for which they prefer to prescribe original brands rather than generics. The clear leader was the anti-hypertensive category, which was cited by 45.0% of respondents. Other prominent categories included hypnotic analgesics and anxiolytic agents (15.0% of respondents), anti-bacterials (12.0%), anti-diabetics (9.0%), and bronchodilators (9.0%).
Outlook and Implications
The pharmacist responses will make uncomfortable reading for the government, which has been aiming to drastically increase the number of generic substitutions, not least because it suggests that the proportion of generic substitutions may have peaked already. The government will also be uneasy about the fact that the number of prescriptions prohibiting generic substitution appears to be on the decline. Nextit's survey suggests that 33.2% of prescriptions prohibited generic substitution, while a survey conducted by the generics manufacturer and retailer Nihon Chouzai (Japan) on 7-8 June revealed that these prescriptions accounted for 40% of the total (see Japan: 30 June 2008: Japanese Generic Substitution Rates Reach 29% in May).
For the time being, the government can rely on the support of pharmacists, as the survey revealed that 78.5% of respondents claimed the four-point premium for systems for dispensing generics, which pharmacists are entitled to if generics account for over 30% of the total number of prescriptions filled. However, patients themselves are also clearly playing an important role in the overall dynamic.
Meanwhile, Pfizer's defensive strategies for Norvasc appear to be paying dividends. Its patent expired in March, and around 10 generic formulations of amlodipine were due to hit the market in late June or early July (see Japan: 18 March 2008: Pfizer to Bolster Norvasc in Japan as Newer Drugs Win Approval).