Pharmacy Reports

Original and generic medicines: clinical, economic and social aspects in the context of health care systems

Marcin Lewandowski — 2025-11-25

This narrative review synthesizes evidence on clinical, regulatory, economic, and social aspects of generic drug use, focusing on European and Polish contexts. We searched MEDLINE/PubMed, Embase, Scopus, Web of Science, Cochrane Library, and regulatory sources for English and Polish-language records published January 2015 to October 2025. Regulatory authorities apply rigorous bioequivalence and Good Manufacturing Practice standards ensuring generics meet the same quality requirements as branded counterparts. Across most small-molecule indications, these standards predict comparable therapeutic outcomes, with residual caution for narrow-therapeutic-index or modified-release medicines. Despite regulatory assurance, perceptions of inferiority persist among healthcare professionals and patients, influenced by misinformation, inconsistent communication, and branding cues. Economically, generics consistently reduce public and out-of-pocket expenditures and enable reinvestment in innovative therapies. Policy tools such as reference pricing, INN prescribing, and pharmacist substitution shape uptake, though implementation varies. Supply-chain vulnerabilities and market-sustainability pressures threaten continuity of access. Four priority actions emerge: improve transparency of regulatory decisions and product-level information at point of care, standardize professional and public education on generic equivalence, protect sustainable competition through calibrated pricing and diversified sourcing, and prioritize real-world comparative research in sensitive indications. These measures would strengthen trust, ensure reliable access, and allow savings to be reinvested in high-value innovation.

Drug utilization patterns and dosing appropriateness of antirheumatic drugs in outpatients with rheumatoid arthritis at Harapan dan Doa General Hospital, Bengkulu City, Indonesia

Silvia Juniarti — 2025-11-24

Rheumatoid arthritis (RA) is an autoimmune disease that requires long-term treatment and careful management. Inappropriate therapy may increase morbidity and mortality; therefore, appropriate drug selection and prescribing are essential to improving healthcare quality, particularly in hospital settings. This study aimed to determine the prescribing patterns of medications for patients with rheumatoid arthritis at Harapan dan Doa General Hospital in Bengkulu City. A descriptive, quantitative design was employed, utilizing a total sampling technique. The results showed that, based on drug combination patterns, most patients received triple-drug therapy (46.66%), followed by dual therapy (31.61%) and monotherapy (21.64%). The most common monotherapy was etoricoxib (8.33%), while the most frequent two-drug combination was methotrexate and methylprednisolone (11.66%). The predominant three-drug combination consisted of methotrexate, methylprednisolone, and meloxicam (15%). Based on therapeutic class, the prescribed drugs included nonsteroidal anti-inflammatory drugs (NSAIDs) (80%), corticosteroids (71.66%), disease-modifying antirheumatic drugs (DMARDs) (61.66%), and analgesics (10%). Although all prescribed drugs followed the recommended dosing guidelines, NSAIDs and corticosteroids were used more frequently than methotrexate. This pattern may reflect variations in clinical practice or differences in patient characteristics.

Out-of-pocket expenditure in Indonesia’s national health insurance: evidence from household survey in Bandar Lampung City, Indonesia

Atika Dalili Akhmad — 2025-11-25

Indonesia’s National Health Insurance (NHI) was established to promote equitable access to healthcare and protect households from financial hardship. However, out-of-pocket (OOP) payments continue to occur, leading in catastrophic health for many families. This study aimed to measure the incidence and identify the determinants of OOP spending among NHI participants in Bandar Lampung. A cross-sectional survey involving 253 NHI members was conducted in 2020 across clinics, public health centers, and pharmacies. Data were analyzed using chi-square and logistic regression. OOP spending was reported by 31.62% of respondents. Bivariate analysis indicated that the type of health facility (p = 0.004) and membership status (p = 0.040) significantly influenced OOP expenditure, while age, gender, education, occupation, income, and treatment class were not significant. Multivariate analysis confirmed that visits to clinics (p = 0.018) and membership in Mandiri or PBI groups (both p = 0.039) were associated with a higher likelihood of OOP payments. Despite essential health services being covered under NHI, OOP expenditure remains a considerable financial burden. These findings highlight the need for stronger policy interventions to improve benefit coverage and ensure equitable financial protection under Indonesia’s NHI system.