Why people refuse generic substitution: a population survey of public opinion on generic substitution in Finland
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Why people refuse generic substitution: a population survey of public opinion on generic substitution in Finland Reeta Heikkila¨,1 Pekka Ma¨ntyselka¨,2 and Riitta Ahonen1 1 School of Pharmacy, University of Eastern Finland, Kuopio, Finland 2 School of Medicine, University of Eastern Finland, Kuopio, Finland, and Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
In a population survey in Finland conducted to explore why some individuals refuse generic substitution, the main reasons for refusal were satisfaction with their current medicine and/or that a decision on a drug product had been made in co-operation with their physician. Most of these individuals indicated that they would be unwilling to accept generic substitution in the future.
Introduction Generic substitution of prescription medications is used as a way to decrease medical costs in many countries worldwide, but many individuals do not want to use such substitutes. The purpose of this study was to explore the reasons why individuals refused generic substitution, based on data from a population survey in Finland.[1] In Finland, mandatory generic substitution was introduced at the beginning of April 2003, with the aim of curbing the rise in medical expenses for society and individuals. This reform placed the dispensing pharmacy under an obligation to substitute a medical product, prescribed by a physician or dentist, with the cheapest, or close to the cheapest, interchangeable product. However, individual patients or physicians have the right to forbid substitution. Generic substitution was a significant change for both Finnish medicine users and prescribers. According to the prescription register of The Social Insurance Institution of Finland, only 10% of patients refused generic substitution in 2008.[2] However, the reasons for their refusal of generic substitution are not known. According to previously published survey data,[1] individuals who had refused generic substitution in Finland were mostly (66%) women, more than half of them were aged ‡60 years and many of them used prescription medicines regularly. In European studies, age had variable influences on the refusal of generic substitution and belief in generic medicines. Older age was associated with nonacceptance of generic substitution[3] or a stronger belief in the similarity of generic and brand name medicines than that shown by younger participants,[4,5] but younger participants had a stronger Drugs Ther Perspect 2012; Vol. 28, No. 8
belief in the efficacy of generic and brand name medicines.[5] A low educational level[3-5] and influence of the physician[3,6,7] also affect the individual’s willingness to accept and belief in generic medicines. The seriousness of the illness also has an effect on the acceptability of generic medicines, with individuals’ willingness to receive such medicines decreasing with increasing disease severity.[5]
Methods The population survey was carried out in 2008. A random sample was drawn from five mainland counties. The sixth ˚ land, was
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