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These measures have resulted in some progress; e.g., there has been an increase in the use of generics in Portugal [ 21], generic substitution has been welcomed in Finland [ 17], and there are incentives for pharmacists' to dispense generics in France [ 22].
Demand-side measures, collated under the four Es education, engineering, economics, and enforcement [ 5] include general practitioners' incentives to prescribe generic drugs [ 12- 14], pharmacists' use of generics in substitution for originator drugs [ 15- 18], and consumers' attitudes to generic drugs [ 17- 20].
Most countries promote the use of generic drugs, and several countries have introduced generic substitution in order to increase the use of generics [ 1- 6].
The GPs believed that a standard guideline on generic substitution, collaboration with pharmacists, patient education, and information on the safety and efficacy of generic medicines were necessary to ensure quality in the use of generics.
Most European governments have cut prices and want use of generics.
Some economists say that many Medicare enrollees, through carefully planned use of generics, can avoid reaching the doughnut hole altogether.
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Translating this situation to clinical practice would imply the exposure of thousands of patients to demonstrate any difference in survival after exposure to generic gentamicin, and explains the absence of therapeutic failures associated with use of "bioequivalent" generics [38].
The South African government wants prices of branded drugs slashed by as much as 50% by May, and is pushing the wider use of cheaper generics.
Nonetheless, the executive, Anil Soni, chief adviser to the Global Fund's executive director, said the organizations wanted to signal quickly that they endorsed the use of the generics approved by the World Health Organization.
The use of such generics can be associated with unpredictable safety and efficacy implications [ 42].
While much of the push has been to lower prices on branded drugs and permit use of cheaper generics, there is also a growing effort to increase R&D in vaccines and drugs suited to needs in developing countries.
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