In Sweden, Norway, Finland, France, the Netherlands, Spain, there is a mandatory "generic substitution
", ie whatever drug (generic or specific) is prescribed, the pharmacy must issue a generic.
They include that generic substitution
is recommended as part of the pharmacist's dispensing role; that pharmacists should be provided with bioavailability data by regulatory authorities and manufacturers; and that a medicine should only be substituted for with a product containing a different active ingredient in agreement with the prescriber.
"Promoting generic substitution
and therapeutic interchange through prescriber education and more rational substitution policies may offer important opportunities to achieve substantial savings in the Medicare drug benefit program," the authors write.
The nocebo effect: a reason for patients' non-adherence to generic substitution
Another problem is that of generic substitution
which many pharmacists may be unaware of and is practiced.
It establishes and validates reimbursement, forecasting, drug-pricing research, generic substitution
, therapeutic interchange, competitive analysis, purchasing, forumulary development and management, as well as claims adjudication, processing and validation.
in the treatment of epilepsy: case evidence of breakthrough seizures.
Are private physicians more likely to veto generic substitution
of prescribed pharmaceuticals?
The court found that "neither product withdrawal nor product improvement alone is anticompetitive," but "when a monopolist combines product withdrawal with some other conduct, the overall effect of which is to coerce consumers rather than persuade them on the merits and to impede competition, its actions are anticompetitive under the Sherman Act." (171) The court also rejected a defense based on "free riding" since "generic substitution
by pharmacists following the end of Namenda IR's exclusivity period  is authorized by law; is the explicit goal of state substitution laws;" and also "furthers the goals of the Hatch-Waxman Act by promoting drug competition and by preventing the 'practical extension of [the brand firm's] monopoly ...
These drugs have what is called a "narrow therapeutic range." This means that the difference between a beneficial and harmful dose is very slight--additionally, the amount absorbed by the body may be affected by the drug's formulation, making generic substitution
more risky for some people.
In addition, most physicians refer to drugs by their original brand name even when molecularly identical generic versions are available, which may result in inadvertent dispensing of brand-name drugs, especially in states where automatic generic substitution
This is facilitated by the growing use of generic substitution
as a tool of cost containment globally, as governments seek to curb rising healthcare expenditure.