Initiatives to increase the prescribing of low cost generics; the case of Scotland in the international context
Main Article Content
Abstract
Getting the most out of the pharmaceutical budget is critical across all countries as the financial pressures on healthcare systems intensify. In this paper, we review global practice on encouraging the use of low costs generics versus branded pharmaceuticals, including patented products in the same class where care is not compromised. Our review ranges widely among European countries as well as other high income countries, including Abu Dhabi, Japan and the USA, and other low and middle income Countries. There is a particular focus on Scotland, building on previous publications. We conclude based on multiple publications, including several case studies, that achieving efficiency in pharmaceutical spending is possible in virtually all environments, although there are examples of technologies where generic or therapeutic substitution should not be encouraged. However, there is no magic bullet to achieving full and appropriate use of generics. Countries have to be prepared to use a number of different education, economic, engineering and enforcement methods to achieve success. Similarly, different approaches to achieve low prices for good quality generics. The combination of low prices and increased use of generics will help achieve or attain universal healthcare, benefiting all key stakeholder groups. We conclude with a call for greater cross-country learning in pursuit of what should be a common goal for all health systems.
Article Details
How to Cite
GODMAN, Brian et al.
Initiatives to increase the prescribing of low cost generics; the case of Scotland in the international context.
Medical Research Archives, [S.l.], v. 5, n. 3, mar. 2017.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/1071>. Date accessed: 18 dec. 2024.
Keywords
Co-payments, generics, prescribing restrictions, prices, reforms, Scotland
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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82. Grandia L VA. Generics substitution in primary care: summary of the Dutch community pharmacies guidelines. Generics and Biosimilars Initiative Journal (GaBI Journal). 2012;1(2):102-3.
83. Taube D, Jones G, O'Beirne J et al. Generic tacrolimus in solid organ transplantation. Clinical transplantation. 2014;28(5):623-32.
84. Godman B, Baumgartel C. Are generic immunosuppressants safe and effective? BMJ. 2015;350:h3248.
85. Gothe H, Schall I, Saverno K et al. The Impact of Generic Substitution on Health and Economic Outcomes: A Systematic Review. Applied health economics and health policy. 2015;13 Suppl 1:S21-33.
86. Vogler S, Zimmerman N, Leopold C et al. Discounts and Rebates Granted for Medicines for Hospital Use in Five European Countries. The Open Pharmacoeconomics & Health Economics Journal. 2013;5:1-10.
87. Vogler S, Zimmermann N, Habl C et al. The role of discounts and loss leaders in medicine procurement in Austrian hospitals - a primary survey of official and actual medicine prices. Cost effectiveness and resource allocation : C/E. 2013;11(1):15.
88. Bjorkhem-Bergman L, Andersen-Karlsson E et al. Interface management of pharmacotherapy. Joint hospital and primary care drug recommendations. European journal of clinical pharmacology. 2013;69 Suppl 1:73-8.
89. Vernaz N, Haller G, Girardin F et al. Patented drug extension strategies on healthcare spending: a cost-evaluation analysis. PLoS medicine. 2013;10(6):e1001460.
90. Godman B, Wilcock M, Martin A et al. Generic pregabalin; current situation and implications for health authorities, generics and biosimilars manufacturers in the future. GaBI Journal. 2015;4(3):125-35.
91. Editorial. European patent will make medicines cheaper GaBI. Available at URL: http://www.gabionline.net/index.php/Pharma-News/European-patent-will-make-medicines-cheaper.
92. Law360. Highlighting 'Pay For Delay' Concerns. Available at URL: https://www.law360.com/articles/302521/highlighting-pay-for-delay-concerns.
93. Editorial. How originator companies delay generic medicines http://gabionline.net/Reports/How-originator-companies-delay-generic-medicines.
94. Godman B, Campbell S, Suh HS et al. Ongoing measures to enhance prescribing efficiency across Europe: implications for other countries. J Health Tech Assess 2013;1:27-42.
95. Olsson E, Ingman P, Ahmed B et al. Pharmacist-patient communication in Swedish community pharmacies. Research in social & administrative pharmacy : RSAP. 2014;10(1):149-55.
96. Rathe J, Sondergaard J, Jarbol DE et al. Patients' concern about their medicine after a generic switch: a combined cross-sectional questionnaire and register study. Pharmacoepidemiology and drug safety. 2014;23(9):965-73.
97. Simoens S. A reviewof generic medicine pricing in Europe. GaBI. 2012;1(1):8-12.
98. Vogler S. How large are the differences between originator and generic prices? Analysis of five molecules in 16 European countries. Farmeconomia Health economics and therapeutic pathways 2012;13(Suppl 3):29-41.
99. Vogler S. The impact of pharmaceutical pricing and reimbursement policies on generics uptake: implementation of policy options on generics in 29 European countries─an overview. Biosimilars Initiative Journal (GaBI Journal). 2012;1(2):93-100.
100. Truter I, Shankar S, Bennie M et al. Initiatives in South Africa to enhance the prescribing of generic proton pump inhibitors: findings and implications. Journal of comparative effectiveness research. 2015;4(2):123-31.
101. Godman B, Bishop I, Finlayson AE et al. Reforms and initiatives in Scotland in recent years to encourage the prescribing of generic drugs, their influence and implications for other countries. Expert review of pharmacoeconomics & outcomes research. 2013;13(4):469-82.
102. Woerkom M, Piepenbrink H, Godman B et al. Ongoing measures to enhance the efficiency of prescribing of proton pump inhibitors and statins in The Netherlands: influence and future implications. Journal of comparative effectiveness research. 2012;1(6):527-38.
103. Godman B, Abuelkhair M, Vitry A et al. Payers endorse generics to enhance prescribing efficiency; impact and future implications, a case history approach. GaBI. 2012;1(2):21-35.
104. Dylst P, Vulto A, Simoens S. Demand-side policies to encourage the use of generic medicines: an overview. Expert review of pharmacoeconomics & outcomes research. 2013;13(1):59-72.
105. Vogler S, Zimmerman N. How do regional sickness funds encourage more rational use of medicines, including the increase of generic uptake? A case study from Austria. Generics and Biosimilars Initiative Journal (GaBI Journal). 2013;2(2):65-75.
106. Kaplan WA, Ritz LS, Vitello M et al. Policies to promote use of generic medicines in low and middle income countries: a review of published literature, 2000-2010. Health policy. 2012;106(3):211-24.
107. Moe-Byrne T, Chambers D, Harden M et al. Behaviour change interventions to promote prescribing of generic drugs: a rapid evidence synthesis and systematic review. BMJ open. 2014;4(5):e004623.
108. Godman B, Shrank W, Andersen M et al. Comparing policies to enhance prescribing efficiency in Europe through increasing generic utilization: changes seen and global implications. Expert review of pharmacoeconomics & outcomes research. 2010;10(6):707-22.
109. Fraeyman J, Van Hal G, Godman B et al. The potential influence of various initiatives to improve rational prescribing for proton pump inhibitors and statins in Belgium. Expert review of pharmacoeconomics & outcomes research. 2013;13(1):141-51.
110. Moon JC, Godman B, Petzold M et al. Different initiatives across Europe to enhance losartan utilization post generics: impact and implications. Frontiers in pharmacology. 2014;5:219.
111. Voncina L, Strizrep T, Godman B et al. Influence of demand-side measures to enhance renin-angiotensin prescribing efficiency in Europe: implications for the future. Expert review of pharmacoeconomics & outcomes research. 2011;11(4):469-79.
112. Godman B, Persson M, Miranda J et al. Changes in the utilization of venlafaxine after the introduction of generics in Sweden. Applied health economics and health policy. 2013;11(4):383-93.
113. Godman B, Bucsics A, Burkhardt T et al. Potential to enhance the prescribing of generic drugs in patients with mental health problems in austria; implications for the future. Frontiers in pharmacology. 2012;3:198.
114. Dylst P, Vulto A, Simoens S. Analysis of European policy towards generic medicines. Generics and Biosimilars Initiative Journal. 2014;3(1):34-5.
115. Simoens S. International comparison of generic medicine prices. Current medical research and opinion. 2007;23(11):2647-54.
116. Godman B, Wettermark B, Bishop I et al. European payer initiatives to reduce prescribing costs through use of generics. Generics and Biosimilars Initiative Journal 2012;1(1):22-7.
117. Dylst P, Simoens S. Does the market share of generic medicines influence the price level?: a European analysis. PharmacoEconomics. 2011;29(10):875-82.
118. Hassali MA TJ, Saleem F, Haq Nul et al. Generic Substitution in Malaysia: Recommendations from a Systematic Review. Journal of Applied Pharmaceutical Science 2012;2(8):159-64.
119. Godman B, Bennie M, Baumgärtel C et al. Essential to increase the use of generics in Europe to maintain comprehensive healthcare? Farmeconomia: Health Economics and Therapeutic Pathways 2012;13 (Suppl 3):5-20.
120. Wettermark B, Godman B, Jacobsson B et al. Soft regulations in pharmaceutical policy making: an overview of current approaches and their consequences. Applied health economics and health policy. 2009;7(3):137-47.
121. Gustafsson LL, Wettermark B, Godman B et al. The 'wise list'- a comprehensive concept to select, communicate and achieve adherence to recommendations of essential drugs in ambulatory care in Stockholm. Basic & clinical pharmacology & toxicology. 2011;108(4):224-33.
122. Markovic-Pekovic V, Skrbic R, Godman B et al. Ongoing initiatives in the Republic of Srpska to enhance prescribing efficiency: influence and future directions. Expert review of pharmacoeconomics & outcomes research. 2012;12(5):661-71.
123. Godman B, Wetterark B, van Woerkom M et al. Multiple policies to enhance prescribing efficiency for established medicines in Europe with a particular focus on demand-side measures: findings and future implications. Frontiers in Pharmacology Focused Review 2014;5 (Article 106):1-9.
124. Wettermark B, Godman B, Neovius M et al. Initial effects of a reimbursement restriction to improve the cost-effectiveness of antihypertensive treatment. Health policy (Amsterdam, Netherlands). 2010;94(3):221-9.
125. Garuoliene K, Godman B, Gulbinovic J et al. European countries with small populations can obtain low prices for drugs: Lithuania as a case history. Expert review of pharmacoeconomics & outcomes research. 2011;11(3):343-9.
126. Costa J de O, Almeida-Brasil CC, Godman B al. Implementation of clinical guidelines in Brazil: Should academic detailing be used? JPHS 2016;7:105-15.
127. Wettermark B, Pehrsson A, Juhasz-Haverinen M et al. Financial incentives linked to self-assessment of prescribing patterns: a new approach for quality improvement of drug prescribing in primary care. Quality in primary care. 2009;17(3):179-89.
128. Godman B, Wettermark B, Miranda J et al. Influence of multiple initiatives in Sweden to enhance ARB prescribing efficiency following generic losartan; findings and implications for other countries. International journal of clinical practice. 2013;67(9):853-62.
129. Martin A, Godman B, Miranda J et al. Measures to improve angiotensin receptor blocker prescribing efficiency in the UK: findings and implications. Journal of comparative effectiveness research. 2014;3(1):41-51.
130. Abuelkhair M, Abdu S, Godman B et al. Imperative to consider multiple initiatives to maximize prescribing efficiency from generic availability: case history from Abu Dhabi. Expert review of pharmacoeconomics & outcomes research. 2012;12(1):115-24.
131. Simoens S, De Bruyn K, Miranda J et al. Measures to enhance ARB prescribing efficiency in Belgium following generic losartan: impact and implications for the future. Journal of Pharmaceutical Health Services Research 2013;4:173–81.
132. Bennie M, Godman B, Bishop I et al. Multiple initiatives continue to enhance the prescribing efficiency for the proton pump inhibitors and statins in Scotland. Expert review of pharmacoeconomics & outcomes research. 2012;12(1):125-30.
133. WHO Collaborating Centre of Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment 2015. Available at URL: http://www.whocc.no/filearchive/publications/2015_guidelines.pdf.
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135. Godman B, Shrank W, Wettermark B et al. Use of Generics-A Critical Cost Containment Measure for All Healthcare Professionals in Europe? Pharmaceuticals (Basel, Switzerland). 2010;3(8):2470-94.
136. Sermet C, Andrieu V, Godman B et al. Ongoing pharmaceutical reforms in France: implications for key stakeholder groups. Applied health economics and health policy. 2010;8(1):7-24.
137. Dylst P, Vulto A, Simoens S. Analysis of French generic medicines retail market: why the use of generic medicines is limited. Expert review of pharmacoeconomics & outcomes research. 2014;14(6):795-803.
138. Godman B, Sakshaug S, Berg C et al. Combination of prescribing restrictions and policies to engineer low prices to reduce reimbursement costs. Expert review of pharmacoeconomics & outcomes research. 2011;11(1):121-9.
139. Brkičić LS, Godman B, Bogut M et al. Pharmaceutical pricing in Croatia: a comparison of ordinances in 2013 versus 2009 and their potential savings to provide future guidance. GaBI Journal. 2015;4(2):79-89.
140. Andersson KA, Petzold MG, Allebeck P et al. Influence of mandatory generic substitution on pharmaceutical sales patterns: a national study over five years. BMC health services research. 2008;8:50.
141. Godman B, Bucsics A, Burkhardt T et al. Insight into recent reforms and initiatives in Austria: implications for key stakeholders. Expert review of pharmacoeconomics & outcomes research. 2008;8(4):357-71.
142. Bucsics A, Godman B, Burkhardt T et al. Influence of lifting prescribing restrictions for losartan on subsequent sartan utilization patterns in Austria: implications for other countries. Expert review of pharmacoeconomics & outcomes research. 2012;12(6):809-19.
143. Ustawa z dnia 12 maja 2011 r. o refundacji leków, środków spożywczych specjalnego przeznaczenia żywieniowego oraz wyrobów medycznych (Act of 12-th of May 2011 on reimbursement of medicines, food products for special dietary use and medical devices) (Dz.U. 2011 nr 122 poz. 696 z późn. zm.).
144. Obwieszczenie z dnia 28 grudnia w sprawie wykazu refundowanych lekow, srodkow spożywczych specjalnego przeznaczenia żywieniowego oraz wyrobow medycznych (Announcement of 28 December 2016 on list of reimbursed medicines, food products for special dietary use and medical devices). Available at URL: http://www.bip.mz.gov.pl/legislacja/akty-prawne-1/obwieszczenie-z-dnia-28-grudnia-2016-r-w-sprawie-wykazu-refundowanych-lekow-srodkow-spozywczych-specjalnego-przeznaczenia-zywieniowego-oraz-wyrobow-medycznych-na-1-stycznia-2017-r/.
145. McKee M, Stuckler D, Martin-Moreno JM. Protecting health in hard times. BMJ. 2010;341:c5308.
146. Thai LP, Moss JR, Godman B, Vitry AI. Cost driver analysis of statin expenditure on Australia's Pharmaceutical Benefits Scheme. Expert review of pharmacoeconomics & outcomes research. 2016;16(3):419-33.
147. Mansfield SJ. Generic drug prices and policy in Australia: room for improvement? a comparative analysis with England. Australian health review. 2014;38(1):6-15.
148. Ezenduka C, Ubochi V, Ogbonna B. The Utilization Pattern and Costs Analysis of Psychotropic Drugs at a Neuropsychiatric Hospital in Nigeria. British Journal of Pharmaceutical Research. 2014;4(3):325-37.
149. Godman B, Ezenduka C, Bennie M et al. BARRIERS TO THE OPTIMAL USE OF PHARMACOTHERAPY TO MANAGE DEPRESSION AND SCHIZOPHRENIA: IMPLICATIONS AND FUTURE DIRECTION. Basic & clinical pharmacology & toxicology. 2014;115 (Suppl 1):180.
150. Godman B, Bishop I, Campbell SM et al. Quality and efficiency of statin prescribing across countries with a special focus on South Africa; findings and future implications. Expert review of pharmacoeconomics & outcomes research. 2015;15(2):323-30.
151. Novartis. Kenya first country to launch 'Novartis Access', expanding affordable treatment options against chronic diseases. Available at URL: https://www.novartis.com/news/media-releases/kenya-first-country-launch-novartis-access-expanding-affordable-treatment.
152. Bennie M, Bishop I, Godman B et al. Are prescribing initiatives readily transferable across classes: the case of generic losartan in Scotland? Quality in primary care. 2013;21(1):7-15.
153. Bennie M, Bishop I, Godman B et al. Are specific initiatives required to enhance prescribing of generic atypical antipsychotics in Scotland?: International implications. International journal of clinical practice. 2013;67(2):170-80.
154. Barton S. Using clinical evidence. BMJ. 2001;322(7285):503-4.
155. Bero LA, Grilli R, Grimshaw JM et al. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. BMJ. 1998;317(7156):465-8.
156. McGinn D, Godman B, Lonsdale J et al. Initiatives to enhance the quality and efficiency of statin and PPI prescribing in the UK: impact and implications. Expert review of pharmacoeconomics & outcomes research. 2010;10(1):73-85.
157. NHS. Prescriptions Dispensed in the Community. England 2005-2015. Available cia URL: http://content.digital.nhs.uk/catalogue/PUB20664/pres-disp-com-eng-2005-15-rep.pdf.
158. Baumgartel C. Myths, questions, facts about generic drugs in the EU. Generics and Biosimilars Initiative Journal (GaBI). 2012;1(1):34-8.
159. Andersson K, Sonesson C, Petzold M et al. What are the obstacles to generic substitution? An assessment of the behaviour of prescribers, patients and pharmacies during the first year of generic substitution in Sweden. Pharmacoepidemiology and drug safety. 2005;14(5):341-8.
160. Andersson K, Jorgensen T, Carlsten A. Physicians' opinions and experiences of the Pharmaceutical Benefits Reform. Scandinavian journal of public health. 2006;34(6):654-9.
161. Godman B, Persson M, Miranda J et al. Can authorities take advantage of the availability of generic atypical antipsychotic drugs:? Findings from Sweden and potential implications. Journal of Pharmaceutical Health Services Research 2013;4:139–50.
162. Olsson E, Kalvemark Sporrong S. Pharmacists' experiences and attitudes regarding generic drugs and generic substitution: two sides of the coin. The International journal of pharmacy practice. 2012;20(6):377-83.
163. MHRA. Antiepileptic drugs: new advice on switching between different manufacturers’ products for a particular drug. Available at URL: http://www.mhra.gov.uk/Safetyinformation/DrugSafetyUpdate/CON3367162013.
164. Ofori-Asenso R. A closer look at the World Health Organization's prescribing indicators. Journal of pharmacology & pharmacotherapeutics. 2016;7(1):51-4.
165. Ofori-Asenso R, Brhlikova P, Pollock AM. Prescribing indicators at primary health care centers within the WHO African region: a systematic analysis (1995-2015). BMC public health. 2016;16:724.
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169. Vieira FS, Zucchi P. Diferenças de preços entre medicamentos genéricos e de referência no Brasil (Price differences between generic and innovator medicines in Brazil). Rev Saúde Pública 40(3):444-9.
170. Truter I. Impact of Generic Substitution On the Prescribing of Meprobamate-Containing Combination Analgesics In South Africa. Value in health. 2014;17(7):A526.
171. Truter I. Prescribing of meprobamate-containing combination analgesics in South Africa. South African Family Practice 2016;58(6):207-12.
172. Zeng W, Gustafsson LL, Bennie M et al. Review of ongoing initiatives to improve prescribing efficiency in China; angiotensin receptor blockers as a case history. Expert review of pharmacoeconomics & outcomes research. 2015;15(1):157-69.
173. Zeng W. A price and use comparison of generic versus originator cardiovascular medicines: a hospital study in Chongqing, China. BMC health services research. 2013;13(1):390.
174. Zeng W, Zhen J, Feng M et al. Analysis of the influence of recent reforms in China: cardiovascular and cerebrovascular medicines as a case history to provide future direction. Journal of comparative effectiveness research. 2014;3(4):371-86.
175. Zeng W XH, Godman B, Finlayson AE et al. Ongoing initiatives to improve prescribing efficiency in China; statins as a case history Generics and Biosimilars Initiative Journal. 2014;3(3):122-32.
176. Li Y, Xu J, Wang F, Wang B et al. Overprescribing in China, driven by financial incentives, results in very high use of antibiotics, injections, and corticosteroids. Health affairs. 2012;31(5):1075-82.
177. Reynolds L, McKee M. Serve the people or close the sale? Profit-driven overuse of injections and infusions in China's market-based healthcare system. The International journal of health planning and management. 2011;26(4):449-70.
178. Zeng W, Finlayson AE, Shankar S et al. Prescribing efficiency of proton pump inhibitors in China: influence and future directions. BMC health services research. 2015;15(1):11.
179. Li M, Cai J, Zhang P, Fei C, Xu F. Drug Brand Response and Its Impact on Compliance and Efficacy in Depression Patients. Frontiers in pharmacology. 2017;7(540).
180. Moon JC, Flett AS, Godman BB et al. Getting better value from the NHS drug budget. BMJ. 2010;341:c6449.
181. Usher-Smith J, Ramsbottom T, Pearmain H et al. Evaluation of the clinical outcomes of switching patients from atorvastatin to simvastatin and losartan to candesartan in a primary care setting: 2 years on. International journal of clinical practice. 2008;62(3):480-4.
182. Corrao G, Soranna D, La Vecchia C et al. Medication persistence and the use of generic and brand-name blood pressure-lowering agents. Journal of hypertension. 2014;32(5):1146-53; discussion 53.
183. Martikainen JE, Saastamoinen LK, Korhonen MJ et al. Impact of restricted reimbursement on the use of statins in Finland: a register-based study. Medical care. 2010;48(9):761-6.
184. Godman B, Malstrom R, Bennie M et al. Prescribing restrictions - a necessary strategy among some European countries to enhance future prescribing efficiency?'. Reviews in Health Care. 2012;3(1):5-16.
185. Godman B, Schwabe U, Selke G et al. Update of recent reforms in Germany to enhance the quality and efficiency of prescribing of proton pump inhibitors and lipid-lowering drugs. PharmacoEconomics. 2009;27(5):435-8.
186. Moon JC, Bogle RG. Switching statins. BMJ. 2006;332(7554):1344-5.
187. Gellad WF, Donohue JM, Zhao X et al. Brand-name prescription drug use among Veterans Affairs and Medicare Part D patients with diabetes: a national cohort comparison. Annals of internal medicine. 2013;159(2):105-14.
188. Wu H-Y, Huang J-W, Lin H-J et al. Comparative effectiveness of renin-angiotensin system blockers and other antihypertensive drugs in patients with diabetes: systematic review and bayesian network meta-analysis. BMJ. 2013;347.
189. Godman B, Bucsics A, Burkhardt T et al. Initiatives to enhance renin-angiotensin prescribing efficiency in Austria: impact and implications for other countries. Expert review of pharmacoeconomics & outcomes research. 2010;10(2):199-207.
190. Kalaba M, Godman B, Vuksanovic A et al. Possible ways to enhance renin-angiotensin prescribing efficiency: Republic of Serbia as a case history? Journal of comparative effectiveness research. 2012;1(6):539-49.
191. Hesse U, Godman B, Petzold M et al. Impact of delisting ARBs, apart from losartan, on ARB utilisation patterns in Denmark: implications for other countries. Applied health economics and health policy. 2013;11(6):677-85.
192. Weng TC, Yang YH, Lin SJ, Tai SH. A systematic review and meta-analysis on the therapeutic equivalence of statins. Journal of clinical pharmacy and therapeutics. 2010;35(2):139-51.
193. Godman B, Burkhardt T, Bucsics A et al. Impact of recent reforms in Austria on utilization and expenditure of PPIs and lipid-lowering drugs: implications for the future. Expert review of pharmacoeconomics & outcomes research. 2009;9(5):475-84.
194. Parks J, Radke A, Parker G et al. Principles of antipsychotic prescribing for policy makers, circa 2008. Translating knowledge to promote individualized treatment. Schizophrenia bulletin. 2009;35(5):931-6.
195. Leucht S, Cipriani A, Spineli L et al. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet. 2013;382(9896):951-62.
196. Godman B, Petzold M, Bennett K et al. Can authorities appreciably enhance the prescribing of oral generic risperidone to conserve resources?: Findings from across Europe and their implications. BMC medicine. 2014;12(1):98.
197. Godman B, De Bruyn K, Miranda J et al. Generic atypical antipsychotic drugs in Belgium: their influence and implications. Journal of comparative effectiveness research. 2013;2(6):551-61.
198. Pettersson B, Hoffmann M, Wandell P et al Utilization and costs of lipid modifying therapies following health technology assessment for the new reimbursement scheme in Sweden. Health policy. 2012;104(1):84-91.
199. PrescQIPP. Switching rosuvastatin to atorvastatin. Available at URL: https://www.prescqipp.info/rosuvastatin/send/132-rosuvastatin/1692-bulletin-81-rosuvastatin.
200. Audit Scotland. Prescribing in general practice in Scotland. Available at URL http://www.audit-scotland.gov.uk/docs/health/2013/nr_130124_gp_prescribing.pdf.
201. Lothian Prescribing Bulletin 77. Available at URL: http://www.ljf.scot.nhs.uk/PrescribingBulletins/Prescribing%20Bulletins/Lothian%20Prescribing%20Bulletin%20Issue%2077%20January%202016%20FINAL.pdf.
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204. Bogaert P, Bochenek T, Prokop A et al. A Qualitative Approach to a Better Understanding of the Problems Underlying Drug Shortages, as Viewed from Belgian, French and the European Union's Perspectives. PloS one. 2015;10(5):e0125691.
205. Kwon HY, Hong JM, Godman B, Yang BM. Price cuts and drug spending in South Korea: the case of antihyperlipidemic agents. Health policy. 2013;112(3):217-26.