‘Please could I have the original brand?’
‘Of course Madam…you’ll just have to wait three days for us to get it in.’
‘But I rang last week and you said it would be here and I’m right out of tablets.’
‘Perhaps just this time we’ll give you a generic brand and I’ll make a note on the computer.’
‘You said you would do that last month. The generic brands make me burp.’
That’s not possible Madam, the brands are bioequivalent.’
The provision of generic medication is becoming increasingly common. Pharmacists are reminded that patients have the right to make their own decisions with respect to their care, which includes the right to choose the brand of medication they take.
When dispensing a generic medication, pharmacists must obtain informed consent from the patient before substituting and consider other factors such as the health literacy of the patient. Patient counselling, which may require patience and be time consuming, is always necessary to reduce the risk of the patient inadvertently taking duplicate medication. The pharmacist should also inform the patient about the differences they may see when the generic medication is dispensed such as brand, cost, packaging and look of tablets.
When providing a generic substitution, the pharmacist should endeavour to maintain consistency in the generic brand supplied to minimise the potential for further confusion.
Particular care should be taken when dispensing generic medication in high risk scenarios:
- Patients on multiple medication - These patients are often elderly and may have significant cognitive and physical impairments including impaired vision. Adding a label to the box indicating the name of the original brand is not enough.
- Recent hospital discharge - Quite often the patient’s tablets will have been changed and they are discharged from hospital with brands of medication which differ from those they were taking prior to their admission. The primary objective of the pharmacist should be the patient’s optimum health outcome. It is worth being aware that in these circumstances a patient is often unable to absorb any further changes to their medication regime and may require additional care and support.
For more information on appropriate conduct of pharmacists, refer to the Pharmacy Board of Australia’s Code of conduct for pharmacists, available here.
For more information regarding the expected standards of professional behaviour of pharmacists in Australia with respect to brand substitution, refer to standard 3.8 Brand substitution of the Pharmaceutical Society of Australia’s Professional Practice Standards version 5, available here.