Journal of Islamic Marketing

Practice on generic medicine recommendation and dispensing among Jordanian

pharmacists
Hernan E. Riquelme Mohamed Elthani Rosa E. Rios
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To cite this document:
Hernan E. Riquelme Mohamed Elthani Rosa E. Rios, (2011),"Practice on generic medicine
recommendation and dispensing among Jordanian pharmacists", Journal of Islamic Marketing, Vol. 2 Iss 1
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Jordanian
Practice on generic medicine pharmacists
recommendation and dispensing
among Jordanian pharmacists
43
Hernan E. Riquelme and Mohamed Elthani
Kuwait-Maastricht Business School, Salmiya, Kuwait, and
Rosa E. Rios
Australian College of Kuwait, Safat, Kuwait

Abstract
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Purpose The purpose of this paper is to investigate the percentage of generic inventory pharmacists
have in stock, to comprehend why pharmacists in Jordan recommend and dispense generic products.
Design/methodology/approach In total, 104 pharmacists were surveyed using a structured
questionnaire. The questionnaire contained statements about perception of generic products, inclination
to recommend generic products, importance of promotions, factors influencing a recommendation, stock
of generics, and among others. Correlational and discriminant analyses were used to establish
associations between variables to distinguish characteristics between groups.
Findings More than half of the Jordanian pharmacists sampled carry between 20 and 39 per cent
stock of generic drugs and 46 per cent carry more than 40 per cent stock. One-third (33 per cent)
substitutes branded products by generic ones and slightly more (36 per cent) recommend more generic
than branded products as opposed to those who recommend more branded products (24 per cent). Male
pharmacists (49 per cent) tend to recommend more generic products than do females (24.6 per cent) and
those who recommend more branded products are more influenced by sales visits rather than
manufacturers name or bonuses.
Originality/value The paper provides valuable information about the pharmaceutical industry in
Jordan and the empirical study adds insights from pharmacists about generic medicine.
Keywords Jordan, Medicines, Drugs, Generics
Paper type Research paper

Introduction
The generic market expanded tremendously during the period 2000-2004 worldwide.
A generic is a product, which is an officially approved copy of an original product whose
patent has expired, marketed either as a brand or using the generic name (Piribo, 2010a).
The global generics market is said to account for about 10 per cent of the US$500 billion
global pharmaceutical market (Karwal, 2006) and is growing at a higher compounded
growth rate than branded products (Piribo, 2010a; Hoffman et al., 2009). For instance, from
2002 to 2007, the generic global dispensing rate had increased from 40.5 to 58.9 per cent.
In contrast, the dispensing of branded drugs had decreased from 12.9 to 2.8 per cent for the
same period. The growing availability and the rapid use of first time generic drugs have an
impact on prescription drug expenditures (Hoffman et al., 2009). By 2007, generic drugs
globally accounted for almost 60 per cent of prescription drugs dispensed (Snow, 2007). Journal of Islamic Marketing
Vol. 2 No. 1, 2011
pp. 43-54
q Emerald Group Publishing Limited
The authors are grateful to the data collectors and Dr Brian Ridge for valuable suggestions and 1759-0833
editing of the manuscript. DOI 10.1108/17590831111115231
 JIMA This generic market growth will not decline in the near future as over $15 billion in sales of
2,1 brand-name drugs is expected to be lost to generic drugs in 2011 and 2012 (Hoffman et al.,
2009). In fact, Piribo (2010b), the online destination for business intelligence for the biotech
and pharmaceutical industry announced in their latest report that the global generics
market is predicted to reach US$155.7 billion by 2011.
This predicted exponential growth represented an excellent business opportunity for
44 generic drug companies and many businesses have followed the trend in the generic
industry and tried to capitalise on high market share and profits. Several reasons have
been advanced namely, influence of policy makers in health ministries, general
acceptance by pharmacists and patients, laws and regulations, incentives and price.
Given that pharmacists are considered one of the biggest players in the healthcare
system and are the link between physicians and patients, it is no surprise that they are
among the main focus of studies on generic dispensing drugs (Mott and Cline, 2002).
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Pharmacists are one of the main sources of information to patients, and in many cases,
if approved by the prescribing doctor, can substitute brand-name medicine with generic
ones, which is why pharmaceutical companies give them special attention.
Despite the increasing number of studies assessing beliefs and behaviours of
pharmacists towards generic products in some developed countries, not many studies
have reported on the behaviour of pharmacists in relation to dispensing generic drugs in
developing countries. Perhaps, these countries may account for the future growth of
generic products given that their low cost is an important incentive for developing
countries than what it is for developed countries. The research study reported in this
article is based on Jordan and it may reflect a trend among other Gulf Cooperation
Council countries hence its importance.
The overall objective of this research is to investigate pharmacists beliefs and generic
medicine dispensing behaviour. More specifically, the aims of the survey are to investigate
the percentage of generic inventory pharmacists have in stock, to comprehend why
pharmacists in Jordan dispense generic medicines, and to find out what percentage of
pharmacists recommend and or substitute branded medicine by generic ones in particular.
In the next sections of this paper, a review of the Jordanian pharmaceutical market is
described, followed by studies on the perception and behaviours of pharmacists towards
generic medicines. A synthesis of this literature is provided in a diagrammatic form
suggesting the various factors that influence pharmacists recommendation to dispense
generic products.

Background
Jordan has a small population of 5.97 million and is considered a middle-income country
with a gross domestic product (GDP) of slightly greater than US$21 billion with a sizeable
and profitable pharmaceutical industry (Kaplan and Laing, 2005). Jordans
pharmaceutical market is estimated to grow from US$339 million in 2007 to US$540
million by 2013 and its 81 per cent of production is exported to more than 60 countries
(RedOrbit, 2010). Jordans health system comprises cover via multiple public and private
insurance programs, with the Ministry of Health providing about 40 per cent of the total
(ReportLinker, 2010). According to international standards, Jordans pharmaceutical
market is well developed, and it spent 10.8 per cent of its GDPs on health during 2007 and
2.2 per cent of this was on pharmaceuticals alone (Markets, 2009). An estimated 20 per cent
of the countrys GDP is made up from the pharmaceutical industry which is the
 second largest exporting industry. As a result of the re-emergence of the Iraqi market, Jordanian
Jordans pharmaceutical exports grew at a rate of 25 per cent during 2005 and 15 per cent pharmacists
during 2006 with exports of pharmaceutical products estimated to have reached US$325
million in 2007 (Markets, 2009).
About 18 pharmaceutical companies from the market and three companies dominate
the local production: Hitma Pharmaceuticals (Hitma) a Hitman investments
subsidiary Arab Pharmaceutical Manufacturers (APM) and Dar Al Dawa (DAD). 45
Hikma, APM, and DAD are local manufacturers who dominate the local production and
constitute 75 per cent of the output (Kaplan and Laing, 2005). Thus, generics in the
pharmaceutical sector have taken over the market making up about two-thirds of the
total value of the market.
Table I shows the total pharmaceutical market in Jordan, value wise, estimated to be
worth US$191.0 million (price to consumers) during 2008. The total market share of the
top 10 companies equals 50.7 per cent of the total market. It is noteworthy that the first
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and second companies are generics and represent 18.9 per cent. This shows the extent of
the challenge innovator pharmaceutical companies face in Jordan where generic
manufacturing companies have the highest market share.
The total market grew by 16.8 per cent during 2008 and at the same time, the generic
companies Hikma and DAD grew faster than this by 20.8 and 18.1 per cent, respectively,
while some other innovators companies like Novartis and Sanofi-Aventis grew less than
the market (IMS, 2008). From Table I, it can be concluded that the generic manufacturing
companies are dominating the pharmaceutical market in Jordan with higher market
share than the innovators, grow faster than the industry, and at the same time faster than
some innovator companies.
Table II shows the top 10 companies volume wise. There are six companies that
manufacture generics accounting for a market share equal to 39.3 per cent and the four
branded companies market share accounts for 18.9 per cent. The total market size was
40.3 million packs in 2008, and the top 10 companies represent 54 per cent.

Value YTD Value YTD

December 2008 Total value YTD December 2008 Value YTD December
Jordan rank December 2008 growth (%) 2008 market share (%)

Total market
value 0 191,231.5 16.8 100.0
Hikma PLCa 1 23,759.6 20.8 12.4
DADa 2 12,362.8 18.1 6.5
Novartis 3 10,476.8 11.3 5.5
American home 4 8,990.0 25.0 4.7
GlaxoSmithKline 5 8,239.1 17.4 4.3
Sanofi-Aventis 6 8,170.8 11.4 4.3
Pfizer 7 7,827.5 15.1 4.1
Abbott 8 6,020.3 31.6 3.1
Pharma
International 9 5,652.0 33.0 3.0
AstraZeneca 10 5,502.4 26.9 2.9 Table I.
Top 10 pharmaceutical
Note: aGeneric companies companies by value
Source: IMS (2008) in Jordan
 JIMA
Units YTD Units YTD Units YTD
2,1 December 2008 December December 2008 Units YTD December
Jordan rank 2008 growth 2008 market share (%)

Total market
volume 0 40,308.5 9.8 100.0
46 Hikma PLCa 1 7,547.9 21.5 18.7
DADa 2 3,871.5 11.6 9.6
Novartis 3 2,058.8 3.9 5.1
GlaxoSmithKline 4 1,824.0 16.0 4.5
Pharma
Internationala 5 1,240.1 18.4 3.1
Sanofi-Aventis 6 1,162.9 2 3.1 2.9
JPMa 7 1,152.3 2 7.4 2.9
Joswea 8 1,107.6 21.1 2.7
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United Pharm.
Man.a 9 911.1 16.1 2.3
Table II. Pfizer 10 894.6 15.5 2.2
Top 10 pharmaceutical
companies by units Notes: Measure: units (thousands); ageneric companies
in Jordan Source: IMS (2008)

From these two tables, it can be concluded that the generic medicine manufacturers in
Jordan sell high volume (39.3 per cent) and less value (18.9 per cent) while the brand-name
medicine companies sell high value (31.8 per cent) and less volume (18.9 per cent) than
the generic medicine manufacturers. This could be explained by the low prices of generic
medicines in Jordan compared to brand-name drugs.
Despite the fact that the Jordanian pharmaceutical drugs market represents the
second most valuable export commodity of the country, the market size, and per capita
spent on pharmaceuticals is considered small but growing fast among other countries in
the region (ReportLinker, 2010). The reason behind its growth is exports, even though it
does not have that much foreign investment. The countrys products are found to a great
extent in the Middle East region as 90 per cent of its exports go to those regional foreign
markets (JAPM, 2010). Many of these products have an international reputation when it
comes to quality and have already been approved in the USA and Europe. Jordanian
pharmaceutical companies have formed joint ventures and subsidiaries in eight
different Arab and foreign countries (Ryan and Shanebrook, 2004). These practices have
resulted in improved intellectual property rights in Jordan and an ethical reputation that
has attracted many multinational companies to the country regardless of the strict
pricing policy (Kaplan and Laing, 2005).

Factors influencing generic medicine substitution

Previous studies about pharmacists perceptions of generic medicines and their behaviour
towards generic drugs in Jordan are not existent. However, other studies in other parts of
the world are informative and will be reviewed in the next section of this paper.
The use of generic drugs has increased steadily as a result of the economic pressure on
drug budgets to reduce the cost of the health care budgets (Kirking et al., 2001). The fact
that generic medicines are a good alternative to treat many patients illnesses in a timely
and effective manner provides the opportunity for major savings in overall healthcare
 expenditure as they are cheaper than their brand-name equivalents (Haas et al., 2005; Jordanian
Hoffman et al., 2009). In order to illustrate the potential cost saving that can be achieved pharmacists
by pharmacists and patients who opt for generic drugs, a pilot study performed in
Malaysia revealed that pharmacists and patients expenses were reduced by 70 and
61.3 per cent, respectively, through generic drugs substitutions (Ping et al., 2008).
Within the context of generic drugs use, the pharmacists role has changed
throughout the years from a mere dispenser of drugs to a more active role of suggesting 47
generic drug substitution (Ping et al., 2010). Todays pharmacists are not just
recommending generic drug substitution to patients and physicians but also they are
selecting them according to patients therapy compliance (Mott and Cline, 2002).
Pharmacists also serve as educators of generic substitutes, as they instruct patients
and health care providers about the quality and safety of their use (Smith et al., 1991).
Furthermore, pharmacists normally favour substitution (Allenet and Barry, 2003) and
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there is evidence that pharmacists encourage acceptance of generic products (Biga et al.,
2005) and carry considerable stocks (Babar and Awaisu, 2008).
Pharmacists recommendations about the most effective and cost-effective generic
substitute are well accepted by the majority of the physicians and patients (Ping et al.,
2008, Suh, 1999). For example, a survey conducted in Portugal about generic products
concluded that consumers perceive them as effective as branded products, and this view
is strongly shared among the more educated and younger population (Figueiras et al.,
2008). Research has found that older people tend to hold a more accentuated perception
of similarity between generic and brands than the one observed by younger people.
In summary, the pharmacists multifaceted role consists of controlling the use of
medicine, and of deciding whether to stock or not and dispense generic medicines, but it
is up to the general public to recognise their expertise in medicines.
Another factor that had contributed to the increase use of generic drugs is changes in
prevailing laws (Andersson et al., 2005; Allenet and Barry, 2003). Governments have
implemented new generic medicines policies that support their market access, pricing,
and reimbursement benefits for the patient, pharmacist, and physicians (Simoens, 2009).
In some countries in Latin America, there are no restrictions on substituting
a prescribed drug with a less expensive generic medicine, and in addition both
pharmaceutical companies and pharmacists receive government incentives to
manufacture generic medicine and dispense them to the public (Vacca et al., 2008).
France is one country that supported the use of generics by voting for a law that gives
pharmacists the permission to substitute branded products with generics according to
an approved list from their regulatory body, the French Drug Administration (Allenet
and Barry, 2003). This substitutions law was well supported by pharmacists and not
only gave them more autonomy and confidence in the health care system, but also may
have helped the development of the generic market in France by allowing more
substitutions of generics (Al Gedadi and Hassali, 2008). Despite the optimistic
acceptance of the generic substitute law by the pharmacists, they perceived the
implementation as a risky task due to the lack of trust the patients, physicians, and
pharmacy staff place on generic substitute drugs (Allenet and Barry, 2003).
Sweden also implemented a new policy for the substitution of pharmaceutical brands
in 2002. The most important element in this policy is that it obliged pharmacists to
substitute the expensive brands prescribed by the physician with the cheapest generic
available in pharmacy (Andersson et al., 2005).
 JIMA The last recent example of a regulation obliging pharmacists to replace non-rebated
2,1 by rebated drugs occurred in 2007 in Germany, and this favoured the consumption of
generic products (Natz, 2008). Ontario (Canada) had passed a similar rebate law and now
it is backing out of it because of the sometimes exorbitant rebates drug stores receive
from the makers of generic pharmaceuticals, calling the payments tantamount to
kickbacks (Blackwell, 2010). The province of Ontario is mandating that generic
48 medicines be sold at no more than 25 per cent of the cost of the brand-name product,
down from the 50 per cent allowed now, the same source reported.
Practicing pharmacists are generally in favour of substituting brand-name medicine
by generic products (Allenet and Barry, 2003; Babar and Awaisu, 2008) and an
important proportion (51.6 per cent) finds them suitable for many cases (Ping et al., 2010).
However, this perception changes among consumers when they suffer an illness they
perceive as serious and subsequently, they are less inclined to endorse the use of generic
products (Figueiras et al., 2008).
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Pharmacists also agree that consultation with the physician is necessary in the
Narrow Therapeutic Index (NTI) medicines and they do consult them before suggesting
a substitution. The reasons given by pharmacists to substitute a brand for a generic are
mainly based on cost savings for the consumer, the margins they obtain (Babar and
Awaisu, 2008), and the price of the generic medicine (Ping et al., 2010).
From the literature reviewed one can summarise the influence of several factors on
the decision by pharmacists to dispense more or less generic products. These factors are
shown in Figure 1 which represents the framework used in this study. The following
section describes the method used in this study.

Methodology
In total, 104 private sector pharmacists were surveyed using a structured questionnaire
requesting the respondents to tick the extent to which they agreed on particular
statements. The questionnaire contained statements about perception of generic products,
inclination towards recommending generic products over branded products, importance

Efficacy of
generic
Manufacturers
names Side effect of
generic

Recommendation
Bonuses of generic
medicine

Price of
generic
Figure 1.
Factors affecting the Government Promotional
decision to generic activity
medicine
 of promotions, sales people visits and advertising, perception of effectiveness of generic Jordanian
products, factors influencing a recommendation, stock of generics, and demographic pharmacists
characteristics, for example, gender, age, and years of practice. Statements were anchored
on the value of 1 meaning strongly disagree and 5 meaning strongly agree. Descriptive,
univariate, and multivariate statistical analyses were performed on the data using the
SPSS statistical package and they are reported in the next section.
49
Results
The sample of Jordanian pharmacists who responded to the questionnaire is represented
in Table III. From the data, we can conclude that the sample of pharmacists sample is
more or less balanced in terms of gender, with a great majority being relatively young
(about 40 years of age or less) and who have been practicing as pharmacists for about ten
years. One-third of the pharmacists surveyed have more than 11 years of experience. All
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in all, the data suggest the pharmacists represent a credible sample. Further discussion
of the results is provided in the next section.
Pharmacists were asked what they normally recommend more the branded
products, generic ones, or were their recommendations more or less equal. Almost
36 per cent recommend more generic than branded product and 24 per cent the inverse.
This percentage is much less than the percentage of pharmacists recommending
generics (47 per cent) over branded products in Malaysia (Babar and Awaisu, 2008) and
considerably less when compared to a more recent study, also in Malaysia, where
87.2 per cent of pharmacists favour substituting branded for generics (Ping et al., 2010).
More than half (54 per cent) of the Jordanian pharmacists sampled carry between
20 and 39 per cent stock of generic products, 46 per cent carry more than 40 per cent stock.

Characteristics Response rate (%)

Gender
Male 45.2
Female 54.8
Age
20-30 44.2
31-40 36.5
41-50 8.7
.51 10.6
Practicing experience (years)
Up to 5 35.6
6-10 30
11-15 14.4
.15 20
Recommend
More branded drugs 24 (25 pharmacists)
More generic drugs 36 (37 pharmacists)
About the same 40 (42 pharmacists)
Generic medicine stock (%)
,20 1
20-39 53 Table III.
40-59 17 Pharmacist sample
.60 29 profile
 JIMA This is slightly higher than what was reported among Malaysian pharmacists (Babar
2,1 and Awaisu, 2008) and may be due to the large presence of generic medicine
manufacturers in Jordan.
Gender seems to be associated with the recommendation of generic products
(contingency coefficient 0.250; sig. 0.032). Male pharmacists tend to recommend
more (48.9 per cent) generic medicines than females (24.6 per cent).
50 One-third of the sample substitutes branded products by generic ones always
(2 per cent) or sometimes (31 per cent). The complement indicated that they never
substitute branded products by generic (28 per cent) or only do it rarely (39 per cent).
The large proportion of pharmacists who never or rarely substitute brand-name
medicine may seem at odds with the large proportion of generic medicine in stock. This
perhaps can be explained by at least two arguments. One may be the fact that regardless
of pharmacists attitude to substitute a branded drug, they will have to stock generic
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medicine because it may be the doctors prescription or the patients desire.

A second explanation can be the result of a bias in the interviews since the survey was
conducted by medical reps and the pharmacists may have reported what they thought
the medical reps wanted to hear.
In regard to the perception, Jordanian pharmacists have about the effectiveness of
generic medicine, over half the pharmacists surveyed (53.8 per cent) are of the view that
generics are less effective than branded drugs. This is an interesting perception in view of
the fact that there is no evidence, for example, that brand-name cardiovascular medicines
work any better than their cheaper counterparts as reported in the Journal of the American
Medical Association in November 2008 and ratified by the US Federal Trade Commission
(FTC, 1998; FDA, 2003). The Jordanian pharmacists seem to have more negative beliefs
than community pharmacists in Australia who view generic medicine as very safe and
effective (Al Gedadi and Hassali, 2008). A large proportion (78.8 per cent) do not perceive
that generic drugs have more side effects than branded products. There is a statistically
significant negative correlation between the perception of side effects and recommendation
of generic drug as expected; the more pharmacists perceive side effects the less the
tendency to recommend generics (correlation 20.473; x2 13.97; p 0.001).
When asked about the perception of quality standards of generic products versus
branded ones, almost two-thirds see generic products as not meeting the same stringent
standards branded products have to meet. This perception requires further study since a
generic drug must have the same active ingredients, strength, dosage form, and must be
therapeutically equivalent.
Discriminant analysis was performed to identify the variables that could contribute
to differentiate between the group that recommends more generic (37 pharmacists) from
the group that recommends more branded products (25 pharmacists). The summary
Table IV describes the three variables (gender, frequency of substitution, and sales visit)
that were significant discriminators based on their Wilks lambda values. The function
is statistically significant (x2 19.212; p 0.000) and the three variables explain
28 per cent of the variance observed in the dependent variable, that is, recommendation
of generic medicine (canonical correlation 0.529). Table V reports that 72.6 per cent of
the group cases have been correctly classified, and this percentage is statistically
significantly different from a classification by chance. The results indicate the group
that recommends more generic products is characterised by male pharmacists that
substitute doctors prescription of branded products more often. The group that
 recommends more branded medicines is differentiated from the alternative group by the Jordanian
influence of sales visits. pharmacists
An alternative discriminant function was calculated to distinguish between those
pharmacists that agree to substitute branded for generics in difficult medical conditions
(21 subjects) and those who do not (80 pharmacists). Those who disagree with
dispensing generic drugs in delicate medical conditions do so on the basis that they
perceive generic drugs as less effective than branded ones. 51
Even though pharmacists agree that sampling, advertising, bonuses, manufacturers
name, and visits by medical representatives influence their inclination to dispense more
or less generic products, only sales visits appear to discriminate between those who
recommend more generic medicine than branded ones. The marketing effort did not
influence pharmacists to substitute branded by generic in treatment of serious diseases,
for example, patients with epilepsy, or in drugs such as antidepressant and mood
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stabilizers. This is consistent with findings by both Rosenthal et al. (2006) and
Andermann et al. (2007). The perception of pharmacists in this regard may be accounted
by their understanding of bioavailability between branded and generic product because
the latter class of medicines have an NTI and the substitution to generic medication may
cause an increased risk of relapse or withdrawal symptoms.

Conclusions
All in all the results from the study indicate that pharmacists in Jordan tend to
recommend more generic medicine than branded products and it is no surprise that they
carry a substantial percentage of inventory. The pharmacists who dispense more
generic products are male and have a more positive attitude towards generics. Those
who recommend more brand-name medicines are influenced by sales visits and not

Function 1

Sales visits 20.981

Frequent substitution 0.435
Gender 1.525
Constant 0.691 Table IV.
Canonical discriminant
Note: Unstandardized coefficients function coefficients

Predictive group membership

Original count More generic More brand Total

More generic 26 11 37
More brand 6 19 25
Ungrouped cases 18 24 42
More generic (%) 70.3 29.7 100.0
More brand (%) 24.0 76.0 100.0
Ungrouped cases (%) 42.9 57.1 100.0 Table V.
Discriminant
Note: 72.6 per cent of original grouped cases correctly classified classification results
 JIMA so much by manufactures name or bonuses. Notwithstanding these facts, pharmacists
2,1 perceive generics are less effective than branded products and that they do not meet
same strict quality standards as brand-name medicine.
Pharmacists are likely to play a larger role in generic drug dispensing given the
changes in government policies, the costs of branded drugs, and the number of
successful drug patents expiring such as Lipitor.
52
Implications of the findings
The results in this study show that pharmacists in Jordan who do not recommend
substitute brand-name medicines do so because of the perception they have about
generic medicines. This perception may be based on biased information and therefore
pharmacists and their staff should be trained about the appropriateness of generic
medicines and how to answer questions about generic medicines. For example,
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pharmacists and their staff in Jordan should be familiar with the active ingredient of the
drugs and point them out to consumers when comparing the branded product with the
generic. Both pharmacists and doctors in Jordan should be kept abreast of the new
evidence regarding the bioequivalence and effectiveness of generic drugs. Perhaps,
female pharmacists in Jordan need more reinforcement to convince them that generic
products are as effective as brand-name drugs given that there was a relationship
between gender and inclination to recommend or substitute a branded product by a
generic one.
Given the influence of sales representatives and the incentives (e.g. rebates,
reimbursements), some countries provide to dispense generic products, pharmacists and
doctors should be cautious of the ethical dilemmas they face in prescribing a brand-name
drug when a generic one exists or dispensing it if authorized by the prescriber.
Pharmaceutical companies producing only generic medicines may emphasize
communication strategies to support their products effectiveness as being comparable
to that of brand products. Pharmaceutical companies that manufacture both products
are advised to maintain the strategy, since without a doubt, the market for generics will
continue its trend upwards. However, these companies must be careful in their
communication strategy because they may confuse consumers, or consumers may feel
they have been cheated by pharmaceutical manufacturers throughout the years by
paying substantially more than the cheaper generic drug.
Consumers may be informed of the alternative generic drugs and their effectiveness
so they can request further information from their doctors, and request them to write a
prescription allowing substitution.

Limitations
Despite these contributions, we acknowledge the following limitations of this research.
First, the sample was approached by medical sales reps. This may have affected the
responses of the pharmacists to indicate more positively the influence of sales reps visits
and bonuses. Nevertheless, one-third of Jordans pharmacists have shown no quibbles in
reporting that they recommend more generic than branded products. Second,
pharmacies were not randomly selected and represent those in the main cities. Third,
for the reason above and given the study was conducted only in the main cities of Jordan,
the results cannot be generalised.
 References Jordanian
Al Gedadi, N. and Hassali, M.A. (2008), Pharmacists view on generic medicines: a review of the pharmacists
literature, Journal of Generic Medicines, Vol. 5, pp. 209-18.
Allenet, B. and Barry, H. (2003), Opinion and behaviour of pharmacists towards the substitution
of branded drugs by generic drugs: survey of 1000 French comminity pharmacists,
Pharmacy World & Science, Vol. 25, pp. 197-202.
Andermann, F., Duh, M., Gosselin, A. and Paradis, P. (2007), Compulsory generic switching of 53
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Corresponding author
Hernan E. Riquelme can be contacted at: hernan@kmbs.edu.kw

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