What are the differences between brand-name and generic medicines and is there a justifiable cause of concern around patient use of generic medication?
Most medicines are available under at least two names: the brand-name medicine, and a generic version of the medicine.
A brand-name medicine represents the original, patented medication, marketed by the pharmaceutical company that first developed it.
Once the patent for a brand-name medicine expires, other manufacturers can start producing and marketing generic forms. These are referred to as generic medicines, and are generally named after the main active ingredient in the medicine.
A great example of a common generic medication is ibuprofen, which is also sold under the brand name Nurofen in the UK.
Generic prescribing is widely used by the NHS, as it is not only equally as safe and effective as brand-name prescribing, but it also infers lower costs.
Generic medicines can often be perceived as less effective, of lower quality and less suited for the treatment of major illnesses. A review published in 2015 concluded that 35.6% of the public holds negative perceptions of generic medicines, a conclusion based on reviewing 52 studies published in English since the year 1980.*
Negative perceptions of generic medicines are problematic as they represent considerable barriers towards wider use.
Brand-name manufacturers have also suggested that generic drugs may be less safe and effective.
Pharmaceutical companies wishing to market a generic medication submit applications to the relevant regulatory authorities based on the initial safety and efficacy data of the branded medicine. They must also show that the generic product that they intend to market is equivalent to said brand-name medicine.
This means that, in reference to the original brand-name medication, the generic medication should have the following:
The generic manufacturers must also demonstrate that their medication has no significant differences in the absorption of the main ingredient.
When and if the generic medicine meets all the above criteria, it is then considered equivalent to the original brand-name medicine.
One area where generic drugs and can and generally do differ is branding: packaging, table colour and/or shape, but also excipients (the inactive substances that serve as a medium or vehicle for the active ingredient). Some patients, unless informed beforehand that their medication has been substituted for a generic version, may be concerned when noticing that the appearance of their medicine has changed.
The manufacturing process for a generic medicine can also differ.
A recent large-scale study investigating the clinical equivalence of generic and brand-name drugs used in cardiovascular disease included a total of 47 studies for analysis. The study incorporated different classes of drugs such as β-blockers (used to treat hypertension), diuretics (used to treat oedema), calcium channel blockers (used to treat hypertension), and blood thinning medication such as warfarin.
The study examined clinical outcomes such as vital signs, adverse effects, laboratory values, and even clinic and emergency room visits. The overall conclusion of the study was that generic and brand-name cardiovascular drugs are similar in nearly all clinical outcomes measured, with only minimal differences where brand-name warfarin was substituted with a generic alternative. This, however, did not lead to any differences in health outcomes.*
"The pharmacy team at Phlo appreciate the cost advantages of generic medicines to the NHS, however we also empathise with patients that are uncomfortable with change.
Our pharmacists are always on hand to discuss any concerns that patients may have around generic prescribing and provide reassurance where needed, while relaying the importance of the NHS financial model.
The NHS is an integral part of our business and our local community and we want this to continue for the foreseeable future.”
Prabhjit Jassal, Superintendent Pharmacist