New drugs are normally prescribed by their brand name. If the drug is covered by a patent, the pharmacist will also dispense the brand, even if the physician has actually prescribed the drug by its generic name: patented drugs are in effect single-source brands.

After patent expiry, generics can enter the market and compete with the original brand. Generics have no medical advantage over brands. Their appeal is that they are cheaper. For branded drugs with high sales, many generic competitors will enter the market after patent expiry. Generics will offer a price advantage by undercutting not only the brand but also one another.

At this point, the question arises whether your doctor will continue to prescribe the original brand or switch to a generic version of the same drug.

Doctors’ attitudes differ greatly from country to country. Today, most health authorities encourage doctors to prescribe generics; but some still put obstacles in the way of generic entry into the market, for example by insisting on lengthy and costly registration procedures. Some health care payers put pressure on doctors (with incentives or penalties) to prescribe generically. Others take the decision out of the doctor’s hands by allowing (or even requiring) the pharmacist to substitute a cheaper generic in place of the prescribed brand.

Generic substitution means that the pharmacist switches the physician’s prescription by dispensing a generic instead of the prescribed brand. Depending on national or state regulations, the pharmacist may do so either with or even without the physician’s prior consent. In some countries, patients may refuse a generic switch; in others, patients who insist on the prescribed brand may be asked to pay the price difference between it and an available generic.

The main reason why the authorities and health care payers support and encourage generic prescribing and dispensing is financial: generics save money.

Related articles

Generics and You (Part 1): What is a generic drug?
Generics and You (Part 3): In which countries are you most likely to receive a generic prescription?
Generics and You (Part 4): Are generics ‘first class’ medicine?
Generics and You (Part 5): Biosimilars
Generics and You (Part 6): The fourth question about generics
Generics and You (Part 7): You and generics