title: Potential Clinical and Economic Impact of Switching Branded Medications to Generics.
abstract: Switching branded to generic medications has become a common cost-containment measure. Although this is an important objective for health care systems worldwide, the impact of this practice on patient outcomes needs to be carefully considered. We reviewed the literature summarizing the potential clinical and economic consequences of switching from branded to generic medications on patient outcomes. A literature search of peer-reviewed articles published 2003-2013 using key words of "generic switching" or "substitution" was conducted using PubMed, OvidSP, and ScienceDirect. Of 30 articles identified and reviewed, most were related to the diseases of the central nervous system, especially epilepsy. Based on our review, potential impacts of switching fell into 3 broad categories: patient attitudes and adherence, clinical and safety outcomes, and cost and resource utilization. Although in many cases generics may represent an appropriate alternative to branded products, this may not always be the case. Specifically, several studies suggested that switching may negatively impact medication adherence, whereas other studies found that generic switching was associated with poorer clinical outcomes and more adverse events. In some instances, switching accomplished cost savings but did so at increased total cost of care because of increased physician visits or hospitalizations. Although in many cases generics may represent an appropriate alternative, mandatory generic switching may lead to unintended consequences, especially in certain therapeutic areas. Although further study is warranted, based on our review, it may be medically justifiable for physicians and patients to retain the right to request the branded product in certain cases.
authors.affiliation: 1University of Minnesota, Department of Experimental and Clinical Pharmacology, College of Pharmacy, Minneapolis, MN; 2Pfizer Inc, New York, NY; and 3Weill Medical College of Cornell University, New York, NY.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Straka
authors.forename: Denis J
authors.initials: DJ
authors.lastname: Keohane
authors.forename: Larry Z
authors.initials: LZ
authors.lastname: Liu
mesh_terms: D001294:Attitude to Health; D017046:Cost Savings; D016527:Drug Costs; D057915:Drug Substitution / Q000191:economics*; D016568:Drugs, Generic / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D055118:Medication Adherence; D016896:Treatment Outcome
chemical_list: D016568:Drugs, Generic