Reforms and initiatives in Scotland in recent years to encourage the prescribing of generic drugs, their influence and implications for other countries

Abstract

Scotland has introduced a number of initiatives to enhance the prescribing of low-cost generic drugs versus originators and patent products in a class where these are seen as similar. The objective of this review is to appraise the influence of the various measures on subsequent utilization patterns and expenditure in high-volume classes to provide guidance. This review is principally a narrative review of published studies. The authors’ found supply-side measures resulted in generic prices as low as 3% of pre-patent loss prices. Multiple demand-side measures resulted in high international non-proprietary name prescribing, and a considerable increase in prescribing efficiency for the proton pump inhibitors, statins, renin–angiotensin inhibitor drugs and selective serotonin reuptake inhibitors. There were no specific activities encouraging the prescription of losartan versus other angiotensin receptor blockers or risperidone versus other atypical antipsychotic drugs following generics and no change in their utilization patterns post generics. The authors can conclude multiple measures are needed to change physician prescribing habits. Authorities cannot rely on any ‘spillover’ effects to affect future prescribing, even in closely related classes.

Keywords::

• ACEIs
• antidepressants
• ARBs
• atypical antipsychotics
• clopidogrel
• demand-side measures
• generics
• PPIs
• Scotland
• statins

Acknowledgements

The authors acknowledge the help of INFARMED with providing data on Portugal and Kathleen Bennett with providing data on Ireland.

Financial & competing interests disclosure

M Bennie and I Bishop are employed by NHS Scotland. The work was in part supported by a grant from the Karolinska Institutet.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.