Subscribe to the OSS Weekly Newsletter!

Register for the OSS 25th Anniversary Event

Generic Drugs and Ambivalent Attitudes

Many patients have lingering doubts, fears or negative perceptions of generic drug equivalents. Why?

Generic drugs offer low-cost alternatives to brand-name drugs and account for over ¾ of the prescriptions filled in Canada. Despite this, many people have lingering doubts, fears or negative perceptions of generic equivalents. Why?

According to Health Canada, a "generic drug is pharmaceutically equivalent to the brand name drug: it contains the identical medicinal ingredients, in the same amounts and in a similar dosage form. Generic medications may have different non-medicinal ingredients than the brand name drug, but the company must show that these do not affect the safety, efficacy, or quality of the drug compared to the brand name drug."

Simply put, in all the ways that count, generic drugs are the same as name-brand options but cost significantly less. Assuming a generic version of their medication is available, why would a consumer choose the pricier option?

According to various surveys and studies, there are a few reasons. A big one is brand trust. Just as some people favour Ford vehicles or Apple computers, pharmaceutical companies have brand recognition and inspire brand loyalty. Whether conscious or unconscious, warranted or not, due to branding, experience or something ephemeral, patients often express a preference for specific brand names.

This ties in with another fairly major factor, how long a drug has been around. Several studies have shown that consumers prefer older drugs, even when newer drugs are equally safe and efficacious. In most countries, generic versions of a pharmaceutical aren't approved by regulatory authorities until the original manufacturer's patent protection has worn off. Typically, this amounts to somewhere between 8 and 15 years. In Canada, the US and the UK, drug patents are 20 years in length. However, the time taken to test drugs and get them approved for sale eats into this monopoly period, meaning that by the time a new drug gets to market, a generic version is typically about a decade away.

Even though generic drugs are pharmaceutically equivalent to their name-brand counterparts, they still undergo rigorous safety testing. Nonetheless, the perceived age of the name-brand option can influence how patients feel about the generic choice. A 2020 study found that "although there is a small segment of the population that chooses the newer option, believing it to be of greater efficacy, most consumers believe that an older drug is both safer and more efficacious." Even when participants were given a "no preference" option, more than half still opted for the older medication. The researchers found a "consistent pattern in which, on average, participants thought that older products were both more effective and safer, even when they were clearly informed (and they know they were informed) otherwise." Essentially, consumers' goodwill and trust in a drug seem to grow with age.

Another element of this situation is revealed by a 2020 study that found patients more willing to choose generic drugs for conditions perceived to be less serious, like the flu, compared to those considered more serious, like a cardiac disease. This only further implicated the perception of efficacy and safety in why people choose name brands over generic ones.

This apparent trust of age is echoed in the findings of a 2022 study that found COVID-19 mRNA vaccines judged as safer and more effective when perceived to be older. By changing the events and discoveries shown on a timeline, researchers were able to influence how old participants perceived mRNA vaccines to be. They found that "accounting for participants' vaccination status, Covid-19 mRNA vaccines received more support – they were judged as better, safer, and more as something people ought to take – when the technology undergirding their development was perceived as having longer existence."

(a) Old timeline – manipulation stimuli, (b) new timeline – manipulation stimuli.

Image source:

Perhaps the most changeable factor in consumers choosing brand name is also one of the most predictable: education. When patients are sufficiently informed on the realities of generic drugs, the reasons not to pick them mostly evaporate. For the vast majority of people in the vast majority of situations, generic drugs offer a cheaper choice with no drawbacks. A 2016 survey found that roughly 1/3 of participants did not fully understand why both generic and name-brand drugs existed, and this comprehension was not affected by education level.

While the landscape is generally shifting towards a positive attitude towards generic drugs, work remains to be done to get the message across fully. If in doubt, ask your doctor if generic versions of your drugs are right for you. You could get a positive surprise on your next pharmacy bill!


Back to top