Table 2.
Potential benefits of substitution at the pharmacy level as identified in the interviews (n=32)
| Benefit | Description of the benefit | Citation from the interview |
| Savings | Society saves on drug costs (n=17) | ‘… that’s where the big money can be saved’ PRESCRIBER06 |
| More patients can receive treatments | Lower prices can improve patients’ willingness and ability to use self-injectable biological products (n=5) | ‘… patient’s involvement in the treatment may be better if he/she gets a cheaper medicine, it is a bit of problem with expensive biological drugs before reaching annual limit for co-payment…’ NURSE01 |
| Patients have better access to biological treatments (n=5) | ‘…lower prices may allow more people to receive treatment…’ PATIENT04 | |
| Patients may start biological treatment earlier (n=3) | ‘… maybe one should not focus only on savings here but just how you can treat patients at an earlier stage…’ INDUSTRY05 | |
| New drug treatments can be introduced without compromising sustainability of pharmacotherapy (n=2) | ‘… with the savings these innovative medicines can be offered to more patients…’ PHARMACIST08 | |
| Continuity of treatments | Treatment can continue smoothly with another product if there is a medicine shortage (n=4) | ‘… if they were in a kind of generic substitution, there would more tools for these disruptions.’ PHARMACIST05 |
| Decreasing prices can increase the pharmacy’s willingness to keep the products in stock (n=2) | ‘And, of course, depending on which price category the product is, if it is always available in the pharmacy as for example insulin, as soon as patient gets his medicine, he can start using it immediately.’ PHARMACIST01 | |
| Patients may receive a 3-month dose of reimbursed medication at the same time if the price of the product falls sufficiently (n=1) | ‘So if that price dropped so much that the customer would get it (dispensed medicine) more to take with, and on the other hand it would be a good thing for the customer not to visit pharmacy every month …’ PHARMACIST14 | |
| Treatment can continue smoothly with another reimbursed product if there is a change in the reimbursement status of the patient’s current medicine brand (n=1) | ‘But even in this situation (the original product is not reimbursed any more) if you speculate that there is a drug substitution and you can switch directly to the biosimilar, so this recipe ‘exchange rally’ is much smaller.’ PHARMACIST01 | |
| Automatic substitution could improve immediate availability if pharmacies were aware of the product that has to be dispensed (n=1) | ‘…for example, in this Neupogen case, you should keep four different products in stock when you don’t know what the doctor prescribes, but with the substitution you only need one product to start the treatment…’ AUTHORITY18 |