Abstract The objective of this article is to analyze the role of competition in selected relevant markets (RM) and its influence on the price differential between generic and reference medicines. This is a case study of 268 commercial presentations of drugs, classified as RM in 2001 and 2016. The data to obtain the degree of concentration came from the database used by Hasenclever (2002) and the 2016 Statistical Yearbook of the Pharmaceutical Market. The prices in 2019 were taken from 10 pharmacy and drugstore websites. The results indicate that the 35% margin on the price of the reference drug imposed at the factory price for the entry of the generic on the market is low compared with the differential average retail prices. Furthermore, it was noted that the greater the number of suppliers, the greater tended to be the price differential between generics and reference medicines.

Resumo O objetivo deste artigo é analisar o papel da concorrência nos mercados relevantes (MR) selecionados e sua influência no diferencial de preços entre medicamentos genéricos e de referência. Trata-se de um estudo de caso sobre 268 apresentações comerciais de medicamentos, classificados em MR em 2001 e 2016. Os dados para obtenção do grau de concentração foram provenientes da base de dados utilizada por Hasenclever (2002) e do Anuário Estatístico do Mercado Farmacêutico de 2016. Os preços praticados em 2019 foram retirados de dez sites de farmácias e drogarias. Os resultados indicam que a margem de 35% sob o preço do medicamento de referência imposta ao preço-fábrica para a entrada do genérico no mercado é baixa em relação ao diferencial de preços médios praticados no varejo. Além disso, notou-se que, quanto maior o número de fornecedores, maior tendia a ser o diferencial de preços entre medicamentos genéricos e de referência.

Resumen Las desigualdades ideológicamente fundadas sobre el concepto biológico de género, determinadas por la herencia sociopatriarcal, han regido históricamente el pensamiento humano. Cuba no escapa de esta realidad y continúa reproduciendo estereotipos sexistas en la construcción de género en sus medios de comunicación. La presente investigación analiza desde una perspectiva cualitativa las asignaciones de género establecidas en el discurso publicitario comercial del canal Cubavisión Internacional (CVI) durante el año 2019, único medio audiovisual institucional en Cuba concebido para público internacional. Se emplea como método el análisis del discurso multimodal y como técnica la entrevista a emisores del canal y a expertos en género y publicidad televisiva. El análisis demuestra que, en el discurso publicitario de CVI, los estereotipos son la base para construir el género; por ello, se explicita la diferencia marcada de paradigmas femeninos y masculinos y la omisión de otros genéricos con preceptos tradicionales. Estos presupuestos inciden en la configuración de una identidad folclorista que asocia Cuba y sus habitantes con un destino turístico heteronormativo, lo que demuestra la permanencia de un discurso publicitario conservador.

Resumo As desigualdades ideologicamente fundamentadas sobre o conceito biológico de gênero, determinadas pela herança sociopatriarcal, vêm regendo historicamente o pensamento humano. Cuba não foge dessa realidade e continua reproduzindo estereótipos sexistas na construção de gênero em seus meios de comunicação. Nesta pesquisa, são analisadas, de uma perspectiva qualitativa, as designações de gênero estabelecidas no discurso publicitário comercial do canal Cubavisión Internacional (CVI) durante 2019, único meio audiovisual institucional em Cuba concebido para o público internacional. É utilizada a análise do discurso multimodal como método e, como técnica, a entrevista com emissores do canal e especialistas em gênero e publicidade televisiva. A análise demonstra que, no discurso publicitário do CVI, os estereótipos são a base para construir o gênero; por isso, são explícitas a diferença marcada de paradigmas femininos e masculinos e a omissão de outros genéricos com preceitos tradicionais. Essas suposições incidem na configuração de uma identidade folclorista que associa Cuba e seus habitantes a um destino turístico heteronormativo, o que demonstra a permanência de um discurso publicitário conservador.

Abstract Inequalities ideologically based on the biological concept of gender, determined by socio-patriarchal heritage, have historically governed human thought. Cuba does not escape this reality and continues to reproduce sexist stereotypes in the construction of gender in its media. From a qualitative perspective, this research analyzes the gender assignments during 2019 in the commercial advertising discourse of the Cubavisión Internacional channel (CVI), the only institutional audiovisual medium in Cuba conceived for an international audience. The multimodal discourse analysis is used as a method, and the interview with broadcasters of the channel and gender and television advertising experts as a technique. The analysis shows that, in CVI’s advertising discourse, stereotypes are the basis for constructing gender; for this reason, the marked difference between feminine and masculine paradigms and the omission of other generics with traditional precepts are made explicit. These presuppositions affect the shaping of a folklore identity that associates Cuba and its citizens with a heteronormative tourist destination, proving the permanence of conservative advertising discourse.

ABSTRACT Background: In developing countries, particularly in Iraq, the use of generic medicines has been increasing in recent years, primarily as a cost-saving measure in healthcare provision. In the Iraqi market, famotidine tablets are available from different pharmaceutical companies. As a result, regular pre-marketing quality testing is required to check the quality and identify which product might safely substitute the innovator product in the event of the innovator brand’s unavailability or high cost. Objective: various quality control tests have been conducted to determine the Pharmaceutical Equivalence of the different generic and brands of Famotidine film-coated tablets marketed in Iraq. Materials and Methods: Four different samples of the most commonly available Famotidine 20 mg tablets in the Iraqi market were tested for drug contents, friability, and hardness. Additionally, the in-vitro drug release and kinetics were evaluated. Results: slight differences in the products’ content were found; however, they were within the acceptable requirement of British Pharmacopeia (BP) and The United States Pharmacopoeia (USP) 30, NF 25. Similarly, the friability and hardness were within the excellent range according to the B.P. and USP. The results of our study indicated that the tested brand (Famodin) and the three generic products (Famosam, Ulceran, and Famodar) of Famotidine tablets have a unique pattern of in-vitro release profiles. However, all the tested brands and generic pills complied with the USP specifications for the immediate release dosage forms except for Famosam. Release kinetic for the four tested products indicates first-order kinetic models. Conclusion: The findings revealed that nearly all of the tested Famotidine tablet brands and generics met the pharmacopeial requirements for oral tablets. As a result, if acquiring the innovative brand of famotidine tablets is difficult to obtain, healthcare providers may be advised to use the tested products instead.

RESUMEN Antecedentes: En los países en vías de desarrollo, especialmente en Irak, el uso de medicamentos genéricos ha aumentado en los últimos años, principalmente como medida de ahorro en la prestación de servicios sanitarios. En el mercado iraquí, los comprimidos de famotidina están disponibles en diferentes empresas farmacéuticas. Por ello, es necesario realizar periódicamente pruebas de calidad previas a la comercialización para comprobar la calidad e identificar qué producto podría sustituir con seguridad al producto innovador en caso de que éste no esté disponible o tenga un coste elevado. Objetivo: se han realizado varias pruebas de control de calidad para determinar la Equivalencia Farmacéutica de los diferentes genéricos y marcas de Famotidina comprimidos recubiertos con película comercializados en Irak. Materiales y métodos: Se analizaron cuatro muestras diferentes de los comprimidos de 20 mg de Famotidina más comunes en el mercado iraquí para determinar el contenido de fármaco, la friabilidad y la dureza. Además, se evaluó la liberación in-vitro del fármaco y su cinética. Resultados: Se encontraron ligeras diferencias en el contenido de los productos; sin embargo, estaban dentro de los requisitos aceptables de B.P. y de la Farmacopea de Estados Unidos (USP) 30, NF 25. Así mismo, la friabilidad y la dureza estaban dentro del rango excelente según la B.P. y la USP. Los resultados de nuestro estudio indicaron que la marca probada (Famodin) y los tres productos genéricos (Famosam, Ulceran y Famodar) de comprimidos de famotidina tienen un patrón único de perfiles de liberación in-vitro. Sin embargo, todas las marcas y los comprimidos genéricos probados cumplieron con las especificaciones de la USP para las formas farmacéuticas de liberación inmediata, excepto Famosam. La cinética de liberación de los cuatro productos probados indica modelos cinéticos de primer orden. Conclusiones: Los resultados revelaron que casi todas las marcas y genéricos de comprimidos de Famotidina probados cumplían los requisitos farmacopeicos para los comprimidos orales. En consecuencia, si resulta difícil adquirir la marca innovadora de comprimidos de famotidina, se puede aconsejar a los profesionales sanitarios que utilicen los productos probados en su lugar.

Resumo Desde 2003, a Câmara de Regulação do Mercado de Medicamentos (CMED) é responsável por estabelecer o preço máximo ao consumidor (PMC) para medicamentos. O objetivo deste estudo é comparar preços praticados na internet com o PMC e verificar como se dá a diferença média de preços entre eles no mercado em dois segmentos de medicamentos existentes no Brasil, os de referência e os genéricos. Foi realizada uma coleta de preços de medicamentos em sítios eletrônicos de farmácias e drogarias e os preços coletados foram comparados com os seus respectivos PMCs para o ano de 2019. Foram analisados 68 fármacos e 268 apresentações comerciais de medicamentos genéricos e de referência relativas a esses fármacos. Observou-se um padrão distinto para a diferença média de preços praticados em relação ao PMC em cada segmento de mercado, sendo que, em sua maioria, os genéricos tendiam a praticar as maiores diferenças e os de referência as menores diferenças. O problema da distorção dos preços praticados em relação ao PMC apontados pela literatura foi confirmado principalmente em relação ao mercado de genéricos. Conclui-se que seria importante uma revisão periódica do PMC levando em conta os preços praticados no varejo.

Abstract Since 2003, the Medicine Market Regulation Chamber (CMED, in portuguese) has been responsible for establishing the maximum consumer prices (MCP) for medicines. The aim of this study is to compare prices practiced on the internet with the MCP and identify the average price difference between them in two segments of existing drugs in Brazil, the reference and the generic ones. Drug prices were collected on websites of pharmacies and drugstores and compared with their respective MCP for the year 2019. The analysis included 68 drugs and 268 commercial presentations of generic and reference drugs related to these drugs. A different pattern was observed for the average price difference in relation to the MCP in each market segment, with most generic drugs tending to show the highest differences and the reference drugs the lowest ones. The problem of price distortion in relation to the MCP pointed out by the literature was confirmed mainly in relation to the generic drug market. It was concluded that a periodic review of the MCP would be important, considering retail prices.

RESUMEN Introducción: La formación que reciben los médicos es fundamental para su futuro como profesionales; ideas erróneas sobre los medicamentos genéricos pueden influir negativamente en su prescripción. Objetivo: Identificar la percepción y el uso de medicamentos genéricos de médicos en formación. Métodos: Estudio cuantitativo, descriptivo y transversal, realizado en estudiantes de medicina de una Universidad Pública del Sureste de México. La población de estudio se conformó por una muestra depurada de 522 estudiantes matriculados durante el periodo escolar febrero-junio de 2020, quienes mediante convocatoria abierta llenaron un formulario (Google Forms) tipo escala de Likert. Resultados: La apreciación de los estudiantes hacia un medicamento de patente es superior, tendiendo a una mayor fiabilidad en casos de gravedad. Los medicamentos genéricos son vistos como de mala calidad y se tiene la creencia de que los existentes en el mercado son piratas o copias ilegales. Conclusión: Los resultados sugieren que los médicos en formación tienen una percepción negativa hacia las Especialidades Farmacéuticas Genéricas, las consideran menos eficaces y de calidad dudosa. Pese a esta consideración, los genéricos suelen ser usados en padecimientos leves y refieren obtener buenos resultados.

ABSTRACT Introduction: The medical education receive is critical to their professional future. Misconceptions about generic drugs can negatively influence your prescription. Objective: Identify the perception and use of generic drugs in trained physicians. Methods: Quantitative, descriptive and cross-sectional study carry out in medical students at a public university in southeastern Mexico. The study population consisted of a purified sample of 522 students enrolled during the February-June 2020 school year, who by open call filled out a Likert scale form (Google Forms). Results: Students' appreciation of a patent drug is superior, taking into account greater reliability in cases of seriousness. Generic drugs are seen as of poor quality and it is believed that those on the market are pirates or illegal copies. Conclusions: The results suggest that trained physicians have a negative perception of Generic Pharmaceutical Specialties, considering them less effective and of dubious quality. Despite this consideration, generics are often used in mild conditions and refer good results.

Resumo Desde 2003, a Câmara de Regulação do Mercado de Medicamentos (CMED) é responsável por estabelecer o preço máximo ao consumidor (PMC) para medicamentos. O objetivo deste estudo é comparar preços praticados na internet com o PMC e verificar como se dá a diferença média de preços entre eles no mercado em dois segmentos de medicamentos existentes no Brasil, os de referência e os genéricos. Foi realizada uma coleta de preços de medicamentos em sítios eletrônicos de farmácias e drogarias e os preços coletados foram comparados com os seus respectivos PMCs para o ano de 2019. Foram analisados 68 fármacos e 268 apresentações comerciais de medicamentos genéricos e de referência relativas a esses fármacos. Observou-se um padrão distinto para a diferença média de preços praticados em relação ao PMC em cada segmento de mercado, sendo que, em sua maioria, os genéricos tendiam a praticar as maiores diferenças e os de referência as menores diferenças. O problema da distorção dos preços praticados em relação ao PMC apontados pela literatura foi confirmado principalmente em relação ao mercado de genéricos. Conclui-se que seria importante uma revisão periódica do PMC levando em conta os preços praticados no varejo.

Abstract Since 2003, the Medicine Market Regulation Chamber (CMED, in portuguese) has been responsible for establishing the maximum consumer prices (MCP) for medicines. The aim of this study is to compare prices practiced on the internet with the MCP and identify the average price difference between them in two segments of existing drugs in Brazil, the reference and the generic ones. Drug prices were collected on websites of pharmacies and drugstores and compared with their respective MCP for the year 2019. The analysis included 68 drugs and 268 commercial presentations of generic and reference drugs related to these drugs. A different pattern was observed for the average price difference in relation to the MCP in each market segment, with most generic drugs tending to show the highest differences and the reference drugs the lowest ones. The problem of price distortion in relation to the MCP pointed out by the literature was confirmed mainly in relation to the generic drug market. It was concluded that a periodic review of the MCP would be important, considering retail prices.

Resumo Introdução O Ministério da Saúde, pela Política Nacional de Medicamentos, Portaria no 3.916, de 30 de outubro de 1998, reforça a Lei de Genéricos de fevereiro de 1999 (Lei no 9.787, de 10 de fevereiro de 1999, visando, entre outras coisas, reduzir os preços e facilitar o acesso aos medicamentos para a população). Objetivo Identificar o nível de conhecimento da população em relação aos medicamentos genéricos. Método Estudo descritivo, quantitativo, com 520 usuários entrevistados em quatro unidades de saúde que implementaram o Programa Saúde da Família e que representam quatro distritos sanitários de saúde em Foz do Iguaçu (PR), Brasil. Resultados A maioria dos entrevistados conhece e/ou já ouviu falar do genérico. Para muitas pessoas, o medicamento genérico representa apenas um tipo de medicamento mais acessível. Conclusão Achados indicam a necessidade de educação em saúde para esclarecer a população, para que possam identificar e adquirir seus medicamentos com segurança e confiança.

Abstract Background The Brazilian Ministry of Health, by the National Policy on Medication, Ordinance 3916 from October 30th 1998, reinforces the Law of Generics of February 1999 (Law No. 9787 from February 10th, 1999, aiming, among other things, to reduce the prices and make access to medications easier for population). Objective The main objective was to identify the level of knowledge of the population regarding generic drugs. Method Descriptive, quantitative study, with 520 users interviewed in four health care units that implemented the Brazilian Family Health Program. Such units represent four health districts in Foz do Iguaçu, PR, Brazil. Results Most of the interviewed know and/or have heard about generic drugs. For many people, the generic drug represents only a more affordable type of medication. Conclusion The need for health education to clarify the population’s questions was found, so they could identify and acquire their medication safely and with confidence.

Abstract Background: In Germany over-the-counter medications (OTC) – which since 2004 are no longer subject to binding prices – can only be purchased in pharmacies. Pharmacy owners and their staff therefore have a special responsibility when dispensing, advising on and setting the prices of medications. Objective: The aim of this study was to assess medication dispensing, additional therapeutic recommendations and pricing practices for acute diarrhoea in adults and to evaluate the role of the patient’s approach (symptom-based versus medication-based request) in determining the outcome of these aspects. Methods: A cross-sectional study was conducted from 1 May to 31 July 2017 in all 21 community pharmacies in a medium-sized German city. Symptom-based and medication-based scenarios related to self-medication of acute diarrhoea were developed and used by five simulated patients (SPs) in all of the pharmacies (a total of 84 visits). Differentiating between the different test scenarios in terms of the commercial and active ingredient names and also the prices of the medications dispensed, the SPs recorded on collection forms whether the scenario involved generic products or original preparations as well as whether recommendations were made during the test purchases regarding an additional intake of fluids. Results: In each of the 84 test purchases one preparation was dispensed. However, a preparation for oral rehydration was not sold in a single test purchase. On the other hand, in 74/84 (88%) of test purchases, medications with the active ingredient loperamide were dispensed. In only 35/84 (42%) of test purchases, the patient was also recommended to ensure an ‘adequate intake of fluids’ in addition to being dispensed a medication. In symptom-based scenarios significantly more expensive medications were dispensed compared to the medication-based scenarios (Wilcoxon signed rank test: z = -4.784, p < 0.001, r = 0.738). Also within the different scenarios there were enormous price differences identified – for example, in the medication-based scenarios, even for comparable loperamide generics the cheapest preparation cost EUR 1.99 and the most expensive preparation cost EUR 4.53. Conclusions: Oral rehydration was not dispensed and only occasionally was an adequate intake of fluids recommended. There were also enormous price differences both between and within the scenarios investigated.

RESUMEN Los medicamentos genéricos son una alternativa para mejorar el acceso a las medicinas que la población necesita y, además, hacen más sostenibles los programas de salud públicos y privados. Se ha seleccionado información y evidencia científica sobre este tipo de medicamentos de tal manera que los lectores -médicos, financiadores, organismos públicos y privados-puedan conformar su propia opinión y ayudar a tomar las decisiones más efectivas y eficientes. La relación existente entre los precios de estos productos y la protección de la propiedad intelectual a través de las patentes de los medicamentos es un centro de conflictos entre la industria farmacéutica y los sistemas de salud. En los Estados Unidos, la ley Hatch-Waxman ha cumplido una función muy importante al estimular el desarrollo de medicamentos genéricos. En un mismo intento, la Unión Europea (UE) ha desarrollado, a través de la Agencia Europea del Medicamento (EMA), una homogeneización en materia de autorización de medicamentos y exclusividad de los datos.

SUMMARY Generic medicines give the chance to improve access to medicaments that the population needs, and the possibility of making public and private health programs more sustainable. Information and scientific evidence on this type of medicines has been selected in such a way that the readers - doctors, financiers, public and private organizations - can shape their own opinion and help take the most effective and efficient decisions. The relationship between the prices of these products and the protection of intellectual property through patents for medicines is a center of conflicts between the Pharmaceutical Industry and health systems. In the United States, the Hatch-Waxman Act has played a very important role in stimulating the development of generic drugs. By his side, the European Union (EU) has developed, through the European Medicines Agency (EMA), a homogenization in terms of authorization of medicines and exclusivity of data.

ABSTRACT OBJECTIVE To evaluate trends in the use of generic and non-generic medicines to treat hypertension and diabetes under the Farmácia Popular Program (FP) and its impact on generic medicines sales volume and market share in the Brazilian pharmaceutical market. METHODS This longitudinal, retrospective study used interrupted time series design to analyze changes in monthly sales volume and proportion of medicines sales (market share) for oral antidiabetic and antihypertensive medicines for generic versus non-generic products. Analyses were conducted in a combined dataset that aggregate monthly sales volumes from the Farmácia Popular program and from the QuintilesIMS™ (IQVIA) national market sales data from January 2007 to December 2012. The Farmácia Popular program phases analyzed included: a) 2009 reductions in medicines reference prices (AFP-II) and b) 2011 implementation of free medicines program for hypertension and diabetes, the Saúde não tem preço (SNTP – Health has no price). RESULTS Patterns of use for FP-covered antidiabetic and antihypertensive medicines were similar to their use in the market in general. After one year of the decreases in government subsidies in April 2010, market share of antidiabetic and antihypertensive medicines experienced relative declines of -54.5% and -59.9%, respectively. However, when FP-covered medicines were made free to patients, overall market volume for antidiabetic and antihypertensive generics increased dramatically, with 242.6% and 277.0% relative increases by February 2012, as well as non-generics with relative increase of 209.7% and 279% for antidiabetic and antihypertensive medicines, respectively. CONCLUSIONS Ministry of Health policies on the amount of patient cost sharing and on the choice of medicines on coverage lists have substantial impacts on overall generic sales volume in retail pharmacies.

Resumo: O objetivo do estudo foi conhecer a percepção da população a respeito dos medicamentos genéricos frente aos medicamentos de marca em hospitais do Peru. Participaram 4.914 pessoas maiores de 18 anos, de 13 cidades do Peru; foram classificadas em Lima, além de grandes e pequenas cidades. Foram exploradas as características socioeconômicas, demográficas e de percepção de medicamentos genéricos em comparação com os medicamentos de marca. Determinando as associações para cada intersecção de variáveis, foram calculadas as razões de prevalências (RP) e seus intervalos de 95% de confiança (IC95%), usando regressões de Poisson brutas e ajustadas com variância robusta com Stata 14.0. Dos 4.914 participantes, um 46,7% estavam de acordo com que os medicamentos genéricos são menos eficazes do que os medicamentos de marca, um 49,3% tem recomendado o recomendaria a outras pessoas o uso de medicamentos genéricos, além disso, a análise multivariada encontrou que as pessoas que tinham um ingresso econômico menor a PEN 1.000 eram propensas a recomendar um medicamento genérico (RP = 1,36; IC95%: 1,14-1,63). Os resultados manifestam que a população peruana ainda tem conceitos equívocos e baixa aceitação dos medicamentos genéricos, e o presente estudo deveria servir para desenvolver políticas de saúde, que assegurem o baixo custo e a qualidade na hora de escolher um medicamento.

Abstract: The study aimed to investigate the population’s perceptions of generic drugs compared to original brand-name drugs in Peruvian hospitals. Participation included 4,914 persons 18 years and older in 13 cities in Peru, categorized as Lima, large cities, and small cities. The study explored socioeconomic and demographic characteristics and perceptions of generics in comparison to brand-name drugs. In determining the associations for each intersection of variables, the authors calculated the prevalence ratios (PR) and 95% confidence intervals (95%CI), using crude and adjusted Poisson regression with robust variance with Stata 14.0. Of the 4,914 participants, 46.7% felt that generics are less effective than brand-name drugs and 49.3% had recommended or would recommend generics to other people; multivariate analysis showed that individuals with income less than PEN 1,000 (USD 300) were prone to recommending a generic drug (PR = 1.36; 95%CI: 1.14-1.63). The results indicate that the Peruvian population still has mistaken concepts and low acceptance of generic drugs, and the study should serve to develop health policies that ensure low cost and quality when choosing medicines.

Resumen: El objetivo del estudio fue conocer la percepción de la población con respecto a medicamentos genéricos, frente a los medicamentos de marca, en hospitales del Perú. Participaron del estudio 4.914 personas mayores de 18 años, de 13 ciudades del Perú; clasificándolas en Lima, grandes y pequeñas ciudades. Se exploraron características socioeconómicas, demográficas y de percepción de medicamentos genéricos, en comparación con los medicamentos de marca. Determinando las asociaciones para cada cruce de variables, se calcularon razones de prevalencias (RP) y sus intervalos del 95% de confianza (IC95%), usando regresiones de Poisson crudas y ajustadas con varianza robusta con Stata 14.0. De los 4.914 participantes, el 46,7% estaban de acuerdo con que los medicamentos genéricos son menos eficaces que los medicamentos de marca, el 49,3% ha recomendado o recomendaría a otras personas el uso de medicamentos genéricos, además, el análisis multivariado encontró que las personas que tenían un ingreso económico menor a PEN 1.000 estaban predispuestas a recomendar un medicamento genérico (RP = 1,36; IC95%: 1,14-1,63). Los resultados ponen en manifiesto que la población peruana aún tiene conceptos equívocos y baja aceptación a los medicamentos genéricos. El presente estudio debería servir para desarrollar políticas de salud, que velen por el bajo costo y calidad a la hora de escoger un medicamento.

ABSTRACT OBJECTIVE To evaluate trends in the use of generic and non-generic medicines to treat hypertension and diabetes under the Farmácia Popular Program (FP) and its impact on generic medicines sales volume and market share in the Brazilian pharmaceutical market. METHODS This longitudinal, retrospective study used interrupted time series design to analyze changes in monthly sales volume and proportion of medicines sales (market share) for oral antidiabetic and antihypertensive medicines for generic versus non-generic products. Analyses were conducted in a combined dataset that aggregate monthly sales volumes from the Farmácia Popular program and from the QuintilesIMS™ (IQVIA) national market sales data from January 2007 to December 2012. The Farmácia Popular program phases analyzed included: a) 2009 reductions in medicines reference prices (AFP-II) and b) 2011 implementation of free medicines program for hypertension and diabetes, the Saúde não tem preço (SNTP – Health has no price). RESULTS Patterns of use for FP-covered antidiabetic and antihypertensive medicines were similar to their use in the market in general. After one year of the decreases in government subsidies in April 2010, market share of antidiabetic and antihypertensive medicines experienced relative declines of -54.5% and -59.9%, respectively. However, when FP-covered medicines were made free to patients, overall market volume for antidiabetic and antihypertensive generics increased dramatically, with 242.6% and 277.0% relative increases by February 2012, as well as non-generics with relative increase of 209.7% and 279% for antidiabetic and antihypertensive medicines, respectively. CONCLUSIONS Ministry of Health policies on the amount of patient cost sharing and on the choice of medicines on coverage lists have substantial impacts on overall generic sales volume in retail pharmacies.

BACKGROUND: Costly prescription medicines with existing cheaper alternatives tend to be purchased by medically insured consumers of healthcare. In South Africa medical scheme members pay higher out-of-pocket payments for medicines than those without insurance. AIM: This study explored reasons for co-payments among insured Pretoria medical scheme members purchasing prescription medicines at private retail pharmacies, despite being insured and protected against such payments. SETTING: The study took place in retail pharmacies in Pretoria, Gauteng Province, South Africa. METHODS: An exploratory qualitative study was performed. Semi-structured interviews were conducted among purposefully sampled medical scheme members (12) and nine key informants (six pharmacists and three regulators - one for the pharmaceutical industry, one for medical schemes and one for pharmacists). Three pharmacies (two corporate and one independent) each were identified from high and low socio-economic areas. Scheme members were interviewed immediately after having made a co-payment (eight) or no co-payment (four) from the selected pharmacies. Interviews were recorded, coded and organised into themes. RESULTS: Co-payments were deemed confusing, unpredictable and inconsistent between and within pharmacies. Members blamed schemes for causing co-payments. Six sampled pharmacies rarely stocked the lowest-priced medicines; instead, they dispensed medicines from manufacturers with whom they had a relationship. Corporate pharmacies were favoured compared to independents and brand loyalty superseded cost considerations. Medical scheme members did not understand how medical schemes' function. CONCLUSION: Unavailability of lowest-priced medicines at pharmacies contributes to co-payments. Consumer education about generics and expedited implementation of National Health Insurance could significantly reduce co-payments.

Abstract: The study aimed to investigate the population’s perceptions of generic drugs compared to original brand-name drugs in Peruvian hospitals. Participation included 4,914 persons 18 years and older in 13 cities in Peru, categorized as Lima, large cities, and small cities. The study explored socioeconomic and demographic characteristics and perceptions of generics in comparison to brand-name drugs. In determining the associations for each intersection of variables, the authors calculated the prevalence ratios (PR) and 95% confidence intervals (95%CI), using crude and adjusted Poisson regression with robust variance with Stata 14.0. Of the 4,914 participants, 46.7% felt that generics are less effective than brand-name drugs and 49.3% had recommended or would recommend generics to other people; multivariate analysis showed that individuals with income less than PEN 1,000 (USD 300) were prone to recommending a generic drug (PR = 1.36; 95%CI: 1.14-1.63). The results indicate that the Peruvian population still has mistaken concepts and low acceptance of generic drugs, and the study should serve to develop health policies that ensure low cost and quality when choosing medicines.

Resumen: El objetivo del estudio fue conocer la percepción de la población con respecto a medicamentos genéricos, frente a los medicamentos de marca, en hospitales del Perú. Participaron del estudio 4.914 personas mayores de 18 años, de 13 ciudades del Perú; clasificándolas en Lima, grandes y pequeñas ciudades. Se exploraron características socioeconómicas, demográficas y de percepción de medicamentos genéricos, en comparación con los medicamentos de marca. Determinando las asociaciones para cada cruce de variables, se calcularon razones de prevalencias (RP) y sus intervalos del 95% de confianza (IC95%), usando regresiones de Poisson crudas y ajustadas con varianza robusta con Stata 14.0. De los 4.914 participantes, el 46,7% estaban de acuerdo con que los medicamentos genéricos son menos eficaces que los medicamentos de marca, el 49,3% ha recomendado o recomendaría a otras personas el uso de medicamentos genéricos, además, el análisis multivariado encontró que las personas que tenían un ingreso económico menor a PEN 1.000 estaban predispuestas a recomendar un medicamento genérico (RP = 1,36; IC95%: 1,14-1,63). Los resultados ponen en manifiesto que la población peruana aún tiene conceptos equívocos y baja aceptación a los medicamentos genéricos. El presente estudio debería servir para desarrollar políticas de salud, que velen por el bajo costo y calidad a la hora de escoger un medicamento.

Resumo: O objetivo do estudo foi conhecer a percepção da população a respeito dos medicamentos genéricos frente aos medicamentos de marca em hospitais do Peru. Participaram 4.914 pessoas maiores de 18 anos, de 13 cidades do Peru; foram classificadas em Lima, além de grandes e pequenas cidades. Foram exploradas as características socioeconômicas, demográficas e de percepção de medicamentos genéricos em comparação com os medicamentos de marca. Determinando as associações para cada intersecção de variáveis, foram calculadas as razões de prevalências (RP) e seus intervalos de 95% de confiança (IC95%), usando regressões de Poisson brutas e ajustadas com variância robusta com Stata 14.0. Dos 4.914 participantes, um 46,7% estavam de acordo com que os medicamentos genéricos são menos eficazes do que os medicamentos de marca, um 49,3% tem recomendado o recomendaria a outras pessoas o uso de medicamentos genéricos, além disso, a análise multivariada encontrou que as pessoas que tinham um ingresso econômico menor a PEN 1.000 eram propensas a recomendar um medicamento genérico (RP = 1,36; IC95%: 1,14-1,63). Os resultados manifestam que a população peruana ainda tem conceitos equívocos e baixa aceitação dos medicamentos genéricos, e o presente estudo deveria servir para desenvolver políticas de saúde, que assegurem o baixo custo e a qualidade na hora de escolher um medicamento.

Abstract The objective of this research was to provide soft-computing generics algorithms to manage the primary actions of the maintenance function, through the integration of tangible and intangible assets of a company. The design methodology used is based on the RUP (Rational Unified Process). The implementation was made with the C++ Builder compiler and was used PostgreSQL as database manager. Among the main results obtained are an increased the quality of the process since 100 % of the data collected in the work orders is tabulated in the database, reducing considerably the time of searching information related to work orders issued. It also was achieved a reduction of 13,994.03 hours per year, which translates as an increase in the equipment availability indicator.

Resumen El objetivo de esta investigación fue proporcionar unos algoritmos genéricos informatizados para gestionar las acciones primarias de la función mantenimiento, a través de la integración de los activos tangibles e intangibles de una empresa. La metodología de diseño utilizada se basó en la RUP (Proceso Unificado Racional). La implementación se realizó con el compilador C ++ Builder y se utilizó PostgreSQL como gestor de bases de datos. Para evaluar la efectividad de los algoritmos se analizó un intervalo de tres años antes y tres años después de su implementación. Entre los principales resultados obtenidos se encuentra un incremento de la calidad del proceso, pues el 100 % de la información de los datos recogidos en las órdenes de trabajo se encuentra en una base de datos; reduciendo considerablemente el tiempo de búsqueda de información relativa a las órdenes de trabajo emitidas. Adicionalmente se logró una reducción de 13954,03 horas anuales, destinadas a acciones preventivas o correctivas, lo que se traduce en un aumento en el indicador de disponibilidad de los activos.