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Analyzing generic and branded substitution patterns in the Netherlands using prescription data.

Pechlivanoglou P, van der Veen WJ, Bos JH, Postma MJ - BMC Health Serv Res (2011)

Bottom Line: 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.Individually owned pharmacies had a lower probability of generic substitution compared to chain pharmacies.Individually owned pharmacies were more likely to substitute a generic drug to a branded compared to other pharmacies.

View Article: PubMed Central - HTML - PubMed

Affiliation: Unit of PharmacoEpidemiology and PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, A, Deusinglaan 1, 9713 AV Groningen, The Netherlands. P.Pechlivanoglou@rug.nl

ABSTRACT

Background: As 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.

Methods: We 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.

Results: Generic 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.

Conclusion: Analysis 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.

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Number of linked prescriptions (pharmacy and GP database) and percentages (between brackets) of branded - generic prescribing.
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Figure 1: Number of linked prescriptions (pharmacy and GP database) and percentages (between brackets) of branded - generic prescribing.

Mentions: The linked prescription data consisted of 53,899 prescriptions originating from 4,417 subjects. Of these prescriptions 36,695 (68.1%) were generically prescribed by the GP. From the rest 17,204 (31.9%) branded prescriptions, 4,292 were generically substituted by the pharmacist; i.e. 24.9% of branded was generically substituted. Also, out of all generic prescriptions 3,664 (10%) were filled with a branded drug by the pharmacist (Figure 1).


Analyzing generic and branded substitution patterns in the Netherlands using prescription data.

Pechlivanoglou P, van der Veen WJ, Bos JH, Postma MJ - BMC Health Serv Res (2011)

Number of linked prescriptions (pharmacy and GP database) and percentages (between brackets) of branded - generic prescribing.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3107776&req=5

Figure 1: Number of linked prescriptions (pharmacy and GP database) and percentages (between brackets) of branded - generic prescribing.
Mentions: The linked prescription data consisted of 53,899 prescriptions originating from 4,417 subjects. Of these prescriptions 36,695 (68.1%) were generically prescribed by the GP. From the rest 17,204 (31.9%) branded prescriptions, 4,292 were generically substituted by the pharmacist; i.e. 24.9% of branded was generically substituted. Also, out of all generic prescriptions 3,664 (10%) were filled with a branded drug by the pharmacist (Figure 1).

Bottom Line: 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.Individually owned pharmacies had a lower probability of generic substitution compared to chain pharmacies.Individually owned pharmacies were more likely to substitute a generic drug to a branded compared to other pharmacies.

View Article: PubMed Central - HTML - PubMed

Affiliation: Unit of PharmacoEpidemiology and PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, A, Deusinglaan 1, 9713 AV Groningen, The Netherlands. P.Pechlivanoglou@rug.nl

ABSTRACT

Background: As 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.

Methods: We 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.

Results: Generic 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.

Conclusion: Analysis 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.

Show MeSH