Generic medicines are very important in driving down the health care cost. In a country like South Africa, where more than 80% of the population depend on the state health care, it is important to find ways to reduce cost. The main aim of the study was to evaluate the attitude towards generic medicines by pharmacists in Gauteng province of South Africa. Gauteng as the economic hub of the country, with the highest population and the highest number of pharmacies and pharmacists, obtaining a picture around the attitude towards generic medicines would help the all the stakeholders in the health care sector to identify areas of concern and address them to drive a positive attitude. In order to evaluate the attitude, Fishbein models, which noted the intention to perform the behaviour in question as the immediate antecedent of any behaviour, were used. The models identified two conceptually independent determinants of intention, which are attitude towards the behaviour (personal) and subjective norm (social). Depending of which model one is using, one more determinant of the intention “perceived behavioural control” can be added on the theory of reasoned action to form model of planned behaviour. By evaluating the attitude one can therefore determine the level of intention to perform the behaviour of interest which is generic substitution in this study. An empirical study was conducted among 116 pharmacists and assistants in Gauteng province. The methodology included research design, instrument development, sampling methods, data collection, capturing and statistical analysis. The results were analysed using Cronbach Alpha coefficients to measure reliability of the research instrument, t-test and ANOVA to test the hypothesis and the variance between groups; the effect sizes and Spearman's rho to determine the correlation and relationship between two variables of interest. The results of the study showed that, 94% of the respondents believe that generics are viable alternatives to innovator medicines. On the question of pharmacists’ attitude towards generic medicines results showed that there was no significant difference in almost all the demographic characteristics gender, age, qualifications, employment level, years of experience and type of pharmacy one practices. The only significant driver of the difference in attitude is the location of the pharmacy where pharmacists practicing in the townships and the city centre were found to be more receptive to generics than those in the suburbs. Due to reliability failure on the control belief construct, the theory of planned behaviour was downgraded to theory of reasoned action, to exclude the control belief construct for further statistical analysis. Correlation between the two attitudes constructs, behavioural belief and evaluation of behavioural outcome was one of the highest, where behavioural belief was identified as the direct measure of attitude and also the main driver. The study concluded that attitude is one of the most important personal factors influencing both the organisation and individual consumer buying behaviour. Evaluating individuals’ attitude to the behaviour (use of a product or service) would help marketers to communicate the right message to the right customers. / MBA, North-West University, Potchefstroom Campus, 2015

Generic medicines are very important in driving down the health care cost. In a country like South Africa, where more than 80% of the population depend on the state health care, it is important to find ways to reduce cost. The main aim of the study was to evaluate the attitude towards generic medicines by pharmacists in Gauteng province of South Africa. Gauteng as the economic hub of the country, with the highest population and the highest number of pharmacies and pharmacists, obtaining a picture around the attitude towards generic medicines would help the all the stakeholders in the health care sector to identify areas of concern and address them to drive a positive attitude. In order to evaluate the attitude, Fishbein models, which noted the intention to perform the behaviour in question as the immediate antecedent of any behaviour, were used. The models identified two conceptually independent determinants of intention, which are attitude towards the behaviour (personal) and subjective norm (social). Depending of which model one is using, one more determinant of the intention “perceived behavioural control” can be added on the theory of reasoned action to form model of planned behaviour. By evaluating the attitude one can therefore determine the level of intention to perform the behaviour of interest which is generic substitution in this study. An empirical study was conducted among 116 pharmacists and assistants in Gauteng province. The methodology included research design, instrument development, sampling methods, data collection, capturing and statistical analysis. The results were analysed using Cronbach Alpha coefficients to measure reliability of the research instrument, t-test and ANOVA to test the hypothesis and the variance between groups; the effect sizes and Spearman's rho to determine the correlation and relationship between two variables of interest. The results of the study showed that, 94% of the respondents believe that generics are viable alternatives to innovator medicines. On the question of pharmacists’ attitude towards generic medicines results showed that there was no significant difference in almost all the demographic characteristics gender, age, qualifications, employment level, years of experience and type of pharmacy one practices. The only significant driver of the difference in attitude is the location of the pharmacy where pharmacists practicing in the townships and the city centre were found to be more receptive to generics than those in the suburbs. Due to reliability failure on the control belief construct, the theory of planned behaviour was downgraded to theory of reasoned action, to exclude the control belief construct for further statistical analysis. Correlation between the two attitudes constructs, behavioural belief and evaluation of behavioural outcome was one of the highest, where behavioural belief was identified as the direct measure of attitude and also the main driver. The study concluded that attitude is one of the most important personal factors influencing both the organisation and individual consumer buying behaviour. Evaluating individuals’ attitude to the behaviour (use of a product or service) would help marketers to communicate the right message to the right customers. / MBA, North-West University, Potchefstroom Campus, 2015

Os genéricos surgiram na década de 60 nos Estados e são medicamentos que, no geral, são mais baratos que os inovadores; por isso têm um papel importante no controle e diminuição dos preços dos medicamentos. Os preços mais baixos devem-se a economia com o desenvolvimento e testes clínicos pois esses investimentos já foram realizados pela empresa detentora do medicamento inovador. Em 1999 com a promulgação da Lei 9.787, foi instituída a política de Medicamentos Genéricos no Brasil. A nova Legislação introduziu uma série de inovações e exigências na produção, testes de qualidade e bioequivalência, prescrição, dispensação e preços de medicamentos. Houve reações contrárias iniciais para as quais o Governo teve que tomar medidas regulamentadoras para tentar corrigir os problemas que surgiram. O objetivo do trabalho é analisar as situações que levaram a adoção de tais medidas e sua eficácia. Propõem-se fazer uma analise das mudanças da Legislação de medicamentos genéricos no Brasil durante o período de 1999 a 2002 tendo como pano de fundo as características do mercado farmacêutico brasileiro e as reações do mercado. Para tanto, foram utilizadas notícias em jornais de grande circulação, bem como entrevistas com membros do órgão regulador e da indústria farmacêutica. A legislação brasileira será ainda analisada sob a óptica das recomendações da Organização Mundial da Saúde a fim de termos parâmetros qualitativos para averiguar a sua qualidade e finalmente analisar a influência da mídia e da política nos resultados obtidos pelos genéricos. As alterações da Legislação mostraram-se um artifício interessante para auxiliar o processo de implantação dos genéricos no Brasil e auxiliaram na obtenção dos resultados positivos obtidos no processo de implantação dos genéricos. / Generics first appeared in the United States in the 1960’s, and they are medications which, by and large, are less expensive than the innovative ones. This is why they have an important role in controlling and reducing medication prices. The lower prices are due to the savings with development and clinical tests, since these investments have already been made by the innovative medication proprietor. In 1999, with the promulgation of Law 9.787, a Generic Medication policy was instituted in Brazil. The new Legislation introduced a series of production innovations and demands, product quality and bioequivalence tests, as well as medication prescriptions, dispensations and pricing practices. Initial contrary reactions and problems occurred, forcing the Government to make corrective regulatory measures. This research project aims at analyzing both the conditions that lead to such measures being taken and their efficacy. The proposal herein is to analyze the changes made to the generic medication Legislation in Brazil between 1999 and 2002, keeping the Brazilian pharmaceutical market characteristics and market reactions as a backdrop and also relying on articles published in the major newspapers and on interviews made with members of both the regulation agency and of the pharmaceutical industry. The Brazilian Legislation will also be analyzed from the angle of the World Health Organization’s recommendations in order to provide qualitative parameters to evaluate its quality and, finally, to analyze media and political influence in the results the generic medications reached. Legislation manipulation revealed to be an interesting device to assist in the generic implanting process in Brazil and helped in reaching the positive results obtained in such process.

Os genéricos surgiram na década de 60 nos Estados e são medicamentos que, no geral, são mais baratos que os inovadores; por isso têm um papel importante no controle e diminuição dos preços dos medicamentos. Os preços mais baixos devem-se a economia com o desenvolvimento e testes clínicos pois esses investimentos já foram realizados pela empresa detentora do medicamento inovador. Em 1999 com a promulgação da Lei 9.787, foi instituída a política de Medicamentos Genéricos no Brasil. A nova Legislação introduziu uma série de inovações e exigências na produção, testes de qualidade e bioequivalência, prescrição, dispensação e preços de medicamentos. Houve reações contrárias iniciais para as quais o Governo teve que tomar medidas regulamentadoras para tentar corrigir os problemas que surgiram. O objetivo do trabalho é analisar as situações que levaram a adoção de tais medidas e sua eficácia. Propõem-se fazer uma analise das mudanças da Legislação de medicamentos genéricos no Brasil durante o período de 1999 a 2002 tendo como pano de fundo as características do mercado farmacêutico brasileiro e as reações do mercado. Para tanto, foram utilizadas notícias em jornais de grande circulação, bem como entrevistas com membros do órgão regulador e da indústria farmacêutica. A legislação brasileira será ainda analisada sob a óptica das recomendações da Organização Mundial da Saúde a fim de termos parâmetros qualitativos para averiguar a sua qualidade e finalmente analisar a influência da mídia e da política nos resultados obtidos pelos genéricos. As alterações da Legislação mostraram-se um artifício interessante para auxiliar o processo de implantação dos genéricos no Brasil e auxiliaram na obtenção dos resultados positivos obtidos no processo de implantação dos genéricos. / Generics first appeared in the United States in the 1960’s, and they are medications which, by and large, are less expensive than the innovative ones. This is why they have an important role in controlling and reducing medication prices. The lower prices are due to the savings with development and clinical tests, since these investments have already been made by the innovative medication proprietor. In 1999, with the promulgation of Law 9.787, a Generic Medication policy was instituted in Brazil. The new Legislation introduced a series of production innovations and demands, product quality and bioequivalence tests, as well as medication prescriptions, dispensations and pricing practices. Initial contrary reactions and problems occurred, forcing the Government to make corrective regulatory measures. This research project aims at analyzing both the conditions that lead to such measures being taken and their efficacy. The proposal herein is to analyze the changes made to the generic medication Legislation in Brazil between 1999 and 2002, keeping the Brazilian pharmaceutical market characteristics and market reactions as a backdrop and also relying on articles published in the major newspapers and on interviews made with members of both the regulation agency and of the pharmaceutical industry. The Brazilian Legislation will also be analyzed from the angle of the World Health Organization’s recommendations in order to provide qualitative parameters to evaluate its quality and, finally, to analyze media and political influence in the results the generic medications reached. Legislation manipulation revealed to be an interesting device to assist in the generic implanting process in Brazil and helped in reaching the positive results obtained in such process.

Increasing health care costs is an international problem from which South Africa is not excluded. Prescription medication contributes most to these high health care costs, and methods to reduce their costs to society are implemented worldwide. In South Africa, such a method is a managed care reference medicine price list, as introduced by a PBM (pharmacy benefit management) company. This step had some cost implications in the private health sector in South Africa, and these implications were investigated in this study. Central nervous system (CNS) medicine items are among the top ten medicine items claimed and represent a substantial amount of the costs of all medicine items claimed during the study period. Antidepressants, a subdivision of the CNS agents, comprise the largest share of CNS agents claimed and CNS costs, and were therefore investigated more closely. The objective of this study was to analyse the usage patterns and costs of central nervous system medicine items, and more specifically, the antidepressants, against the background of the implementation of a managed care reference medicine price list in the private sector of South Africa. This study was conducted as a retrospective, non-experimental quantitative research project. The study population consisted of all medicine items claimed as observed on the database over the two-year study period of May 2001 to April 2002 (pre-MPL) and May 2002 to April 2003 (post-MPL). Data were provided by MedschemeTM/lnterpharm, and the Statistical Analysis System® SAS 8.2® was used to extract the data from the database. The central nervous system agents had a prevalence of 8.10% (N=49098736) and a total cost of R757576976.72 over the two-year study period. The cost per CNS item increased by 5.98% or R11.50 per CNS item in the year after MPL implementation, and the cost per prescription containing CNS medicine items increased by 4.09% or R9.07 per prescription. CNS agents are classified into ten sub-pharmacological groups, according to the MIMSC3 (Snyman, 2003:13a). One of these sub-pharmacological groups, antidepressants, comprised 33.97% of all CNS medicine items claimed (N=3978364) and 45.53% of all costs associated with CNS medicine items (N=R757576976.72) over the study period. The number one antidepressant claimed was amitriptyline, a tricyclic antidepressant. Of the antidepressants with generic substitutes, all with the exception of clomipramine, were prescribed at generic substitution rates of more than 50%. After the MPL implementation, generic antidepressant products were more frequently prescribed (16.48% increase, N=617190), although patient co-payments did not decrease immediately. Some innovator products had price reductions after the implementation of the MPL. This study indicates that cost minimisation analyses and retrospective drug utilisation reviews are valuable tools in the evaluation of managed care medicine price lists. / Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.

Increasing health care costs is an international problem from which South Africa is not excluded. Prescription medication contributes most to these high health care costs, and methods to reduce their costs to society are implemented worldwide. In South Africa, such a method is a managed care reference medicine price list, as introduced by a PBM (pharmacy benefit management) company. This step had some cost implications in the private health sector in South Africa, and these implications were investigated in this study. Central nervous system (CNS) medicine items are among the top ten medicine items claimed and represent a substantial amount of the costs of all medicine items claimed during the study period. Antidepressants, a subdivision of the CNS agents, comprise the largest share of CNS agents claimed and CNS costs, and were therefore investigated more closely. The objective of this study was to analyse the usage patterns and costs of central nervous system medicine items, and more specifically, the antidepressants, against the background of the implementation of a managed care reference medicine price list in the private sector of South Africa. This study was conducted as a retrospective, non-experimental quantitative research project. The study population consisted of all medicine items claimed as observed on the database over the two-year study period of May 2001 to April 2002 (pre-MPL) and May 2002 to April 2003 (post-MPL). Data were provided by MedschemeTM/lnterpharm, and the Statistical Analysis System® SAS 8.2® was used to extract the data from the database. The central nervous system agents had a prevalence of 8.10% (N=49098736) and a total cost of R757576976.72 over the two-year study period. The cost per CNS item increased by 5.98% or R11.50 per CNS item in the year after MPL implementation, and the cost per prescription containing CNS medicine items increased by 4.09% or R9.07 per prescription. CNS agents are classified into ten sub-pharmacological groups, according to the MIMSC3 (Snyman, 2003:13a). One of these sub-pharmacological groups, antidepressants, comprised 33.97% of all CNS medicine items claimed (N=3978364) and 45.53% of all costs associated with CNS medicine items (N=R757576976.72) over the study period. The number one antidepressant claimed was amitriptyline, a tricyclic antidepressant. Of the antidepressants with generic substitutes, all with the exception of clomipramine, were prescribed at generic substitution rates of more than 50%. After the MPL implementation, generic antidepressant products were more frequently prescribed (16.48% increase, N=617190), although patient co-payments did not decrease immediately. Some innovator products had price reductions after the implementation of the MPL. This study indicates that cost minimisation analyses and retrospective drug utilisation reviews are valuable tools in the evaluation of managed care medicine price lists. / Thesis (M. Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.