Abstract
BackgroundAs in other societies, pharmaceutical expenditures in the Netherlands are rising every year. As a consequence, needs for cost control are often expressed. One possible solution for cost control could come through increasing generic substitution by pharmacists. We aim to analyse the extent and nature of substitution in recent years and estimate the likelihood of generic or branded substitution in Dutch pharmacies in relation to various characteristics.MethodsWe utilized a linked prescription dataset originating from a general practitioner (GP) and a pharmacy database, both from the northern Netherlands. We selected specific drugs of interest, containing about 55,000 prescriptions from 15 different classes. We used a crossed generalized linear mixed model to estimate the effects that certain patient and pharmacy characteristics as well as timing have on the likelihood that a prescription will eventually be substituted by the pharmacist.ResultsGeneric substitution occurred at 25% of the branded prescriptions. Generic substitution was more likely to occur earlier in time after patent expiry and to patients that were older and more experienced in their drug use. Individually owned pharmacies had a lower probability of generic substitution compared to chain pharmacies. Oppositely, branded substitution occurred in 10% of generic prescriptions and was positively related to the patients' experience in branded use. Individually owned pharmacies were more likely to substitute a generic drug to a branded compared to other pharmacies. Antidepressant and PPI prescriptions were less prone to generic and more prone to branded substitution.ConclusionAnalysis of prescription substitution by the pharmacist revealed strong relations between substitution and patient experience on drug use, pharmacy status and timing. These findings can be utilised to design further strategies to enhance generic substitution.
Highlights
As in other societies, pharmaceutical expenditures in the Netherlands are rising every year
general practitioner (GP) prescriptions were collected from the Registration Network Groningen (RNG) database [10,11], while the pharmacy dispensing information was collected from IADB.nl [12]
The fixed effects estimates indicate that the probability of generic substitution is negatively associated with a high proportion of prior brand use
Summary
Pharmaceutical expenditures in the Netherlands are rising every year. One possible solution for cost control could come through increasing generic substitution by pharmacists. Despite the efforts of governments, insurance companies and health care providers to enhance cost control, health expenditures in the developed world rise every year. The potentials for cost savings due to generic drug use has been recognized relatively early in the Netherlands, where in 1988 already about a quarter of the prescriptions were prescribed using the generic name [3]. The Dutch government, in its effort to contain costs, would stimulate generic use through generic substitution;. Generic substitution was already allowed, provided that the pharmacist would first consult the prescriber, in 1998 the Dutch law stimulated generic substitution further by relaxing this compulsory consultation. The Netherlands belongs to the group of countries with the highest proportion of generic use, with a market volume of generic drugs slightly above 50% of the total national drug volume [4]
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