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Many DTCs have changed their advice to recommend products that have recently become substitutable when the patent of a large product has expired.
Sales patterns depend on the prevalence and nature of the disease in question, the characteristics of the drugs in the group, and also on when the patent expires and which products become substitutable.
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Table 1 shows the five therapeutic groups as well as the pharmacological substances of each therapeutic group, their status regarding substitutability and when substances became substitutable.
* The date when the substance became substitutable according to the Swedish Medical Products Agency given for substitutable substances.
In general, a pharmaceutical becomes substitutable when generic products have been introduced after patent expiry.
Expenditure has decreased since the reform was introduced for several groups where the major products became substitutable, e.g. ACE-inhibitors and statins.
Until July 2003 there was a decrease in the volumes of substitutable PPIs, used both for short- and long-term treatment, to half of the initial volume when omeprazole became substitutable.
As shown in Figure 2, sales of substances that became substitutable after the reform was introduced, constitute the largest volumes in all groups with the exception of the nucleosides and nucleotides.
With deflation on the horizon, zero-bound on interest rates implies the risk of a liquidity trap where money and bonds become perfectly substitutable, where real interest rates become high and rising, thus further pushing down aggregate demand, and where money market fund returns cannot even cover their management costs.
Consequently, the procedures had become highly substitutable with CABG and for patients with severe coronary artery disease.
Additionally, some essential and substitutable reactions became blocked.
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CEO of Professional Science Editing for Scientists @ prosciediting.com