Brand substitution involved identical alternatives: a nationwide study undertaken among Australian community pharmacists

This article documented the Australian community pharmacists' brand substitution practices using identical alternatives (pseudo-generics) and the patients' acceptability. A national mail survey was conducted among 500 Australian community pharmacies from different geographical areas in year 2008. The data of the first 25 original PBS prescription items dispensed on one working day and eligible for generic substitution were collected from each pharmacy. Brand substitution which involved identical alternatives of the originator medicines were identified based on the manufacturers' information stated in the Schedule of Pharmaceutical Benefits Scheme (PBS). Responses were received from 82 pharmacies for a response rate of 16.4%. The pharmacists offered brand substitution for 96.4% of the prescription items which eligible for substitution. About 10% of the substitution recommendations were involved switching of originator medicine to its pseudo-generic alternatives. A total of 10.1% of the pseudo-generic substitution recommendations were declined by the patients. This resulted in an average of AUD$4.44 per item of unnecessary extra-costs paid by the patients for purchasing the originator medicines. This indicated that the existence of pseudo-generics in the PBS market can negatively affect the consumers' welfare in terms of unnecessary extra expenditures for originator medicines that have cheaper identical alternative brands.