Please make this a banner 1.3m long and about 12 cm deep and correct distortions in logo

1. Please make this a banner 1.3m long and about 12 cm deep and correct distortions in logo BUILDING CONSUMER CONFIDENCE IN GENERIC MEDICINES Karen Kaye, Kerren Hosking, Jacqualine Vadja, Lynn Weekes. NPS Better Choices Better Health

2. ABSTRACT Outcome measures: Consumer awareness of campaign messages and consumer reported confidence in using generic medicines based on pre / post telephone surveys of a random selection of the population. Proportion of generic medicines prescriptions dispensed based on administrative claims data. Results: The campaign achieved high media reach and good uptake in pharmacy. Pre and post national consumer surveys of the target populations found that 43% remembered the campaign message generic medicines are an equal choice and 22% recalled the message generic medicines contain the same active ingredient as branded products. At the beginning of the campaign 72% of consumers said they would use a generic medicine and this rose to 77% after the campaign. Generic medicines rose 5% as a proportion of all drugs dispensed on the Pharmaceutical Benefits Scheme after the campaign. Conclusions: Mass audience campaigns can support policies to increase prescription and use of generic medicines by targeting perceptions of their quality and effectiveness. Problem: Generic medicines are an important means of keeping medicines costs affordable in most countries. Uptake of generic medicines can be undermined if prescribers and consumers do not believe they are as effective as branded products. Objectives: To increase confidence and understanding about the safety and efficacy of generic medicines among consumers. Design: National campaign based on social marketing principles with process and impact program evaluation. Setting: Community and primary care. Study population: Consumers aged over 50 years who take medicines, people with chronic conditions, carers and people from culturally and linguistically diverse communities. Interventions: The Generic medicines are an equal choice campaign ran from July 2008 to June 2009. The project included a national awareness campaign comprising television and radio advertising, print editorial and online resources; consumer and health professional information resources; a peer education program for seniors; a digital strategy including social media; education for pharmacy technicians; and in-language resources for non-English speaking communities.

3. INTRODUCTION The World Health Organisation (WHO) describes a generic medicines as a product, usually intended to be interchangeable with an innovator product. In Australia, the Therapeutic Goods Administration requires a generic medicine to be bioequivalent with the innovator brand. Bioequivalence is denoted in the Pharmaceutical Benefits Schedule (PBS) to alert prescribers and dispensers that products are legally substitutable. In June 2007 a series of PBS reforms were implemented to lower the cost of generic medicines to the Australian Government. However, many health professionals and consumers believe that generic medicines are inferior and uptake has been lower than optimal. The consequences are that consumers will not always accept substitution with a generic product in spite of reassurance by the pharmacist. The aim of this work was to increase of confidence of consumers in generic medicines and so increase the levels of substitution for generic products.

4. PROGRAM DESIGN • National campaign based on social marketing principles. • Acting via: • media • community groups • community pharmacy • general practice. • Study population: • Consumers aged over 50 years regularly taking prescription medicines; people with chronic conditions and their carers; culturally and linguistically diverse communities (CALD). Key messages • Generic medicines are an equal choice, they contain the same active ingredient. • Generic medicines meet the same government standards. • Speak with your doctor or pharmacist if you are concerned.

5. INTERVENTIONS • Phase 1: August to October 2008 • TV advertising, block strategy 5.30–7.00pm • Consumer hotline augmented (Medicines Line) • Phase 2: November 2008 to January 2009 • TV, magazine and in store (pharmacy) advertising • Online advertising using interactive quiz and video • Posters for pharmacies and doctor’s rooms • Consumer hotline augmented (Medicines Line) • Pharmacy Toolkit (prescription intake form reflecting best practice guidelines, ancillary label and prescription repeat folders) • Search engine marketing (paid search)

6. INTERVENTIONS (2) • Phase 3: January to July 2009 • Peer education sessions for older people • Pharmacy technician education • Consumer fact sheet: Know your active ingredient • In-language brochures for CALD communities (Chinese, Italian, Greek, Vietnamese) • Radio advertising for CALD communities (Mandarin, Cantonese, Italian) • Radio interviews with bilingual doctors and pharmacists • Medicines Name Finder – online tool & Google gadget – know your active ingredient • Consumer hotline augmented (Medicines Line) • Budget $4.4 million

7. OUTCOME MEASURES • Level of activity, reach and intensity. • Consumer awareness of the key messages based on self reports from random selection of target population, computer-assisted telephone interviewing (CATI). • Consumer confidence in using a generic medicine based on self reports from random selection of target population, CATI interviews. • Proportion of prescribed medicines that were dispensed as a generic product based on administrative claims data. As this campaign was carried out in the midst of more general policy and pricing reforms, the total changes in utilisation and savings is reported but no specific attribution can be made to the campaign.

8. RESULTS: PROCESS MEASURES

9. RESULTS: IMPACT MEASURES Percentage of Medicine Line calls about generics Second two weeks advertising Between advertising First two weeks advertising Pre campaign Results of consumer survey

10. RESULTS: CHANGES IN UPTAKE OF GENERIC PRESCRIPTIONS Number prescriptions (x 000,000) for substitutable products dispensed as innovator or generic brands 48.6% 51.6% 52.3% The NPS campaign occurred as part of wider PBS reforms. PBS price reductions for generic products reduced in Aug 2007 and Aug 2008, pharmacist incentive to dispense generic product introduced in July 2007, NPS campaign ran 2008–2009.

11. RESULTS: CHANGES IN UPTAKE OF GENERIC PRESCRIPTIONS Cost prescriptions (x 000,000) for substitutable products dispensed as innovator or generic brands Compulsory price reductions per policy change occurred Aug 2007 and July 2008; items eligible for substitution equalled 660 in 07–08; 690 in 08–09; 718 in 09–10.

12. RESULTS • Average cost per script Total cost and volume of substitutable scripts (000,000) • Total savings (000,000) from all measures – including major policy reforms

13. CONCLUSIONS • The NPS campaign Generics are an equal choice, achieved high reach and had good uptake in pharmacies. Consumers were able to recall of campaign messages and there was an increased willingness to use generic medicines. • There was a subsequent increase in the proportion of prescriptions for which a generic product was dispensed of 3.7% before and after the campaign. Because this was a period of significant policy reform we have not attempted to attribute the contribution of the campaign to this change or to the resulting savings.