In 2013, generics overall accounted for 67% of the Taiwanese market by quantity, but only 23% by cost [2]. The generics prescribing ratios of dihydropyridine (DHP) derivatives (the proportion of DHP prescribed as generics to all prescribed DHP) of medical facilities in Taiwan were examined in this latest study against the urbanization levels of the clinic location.

In 1995, Taiwan adopted a National Health Insurance (NHI) model similar to the US Medicare system. As a result, the 40% of Taiwanese people who had previously been uninsured are now covered [3]. In this study, the researchers used one subset of the NHI research database, the Longitudinal Health Insurance Database for 2010, which contained claims data belonging to one million people randomly sampled from all NHI beneficiaries in 2010.

Chia-Chen Hse of the Taipei Veterans General Hospital and colleagues found that the aggregate generics prescribing ratio rose from 6.7% at academic medical centres to 15.3% at regional hospitals, 29.4% at community hospitals and 66.1% at physician clinics. Among physician clinics, the generics prescribing ratio in urban areas was 63.9 ± 41.0% (mean ± standard deviation), lower than that in suburban (69.6 ± 38.7%) and in rural (74.1% ± 35.3%) areas. In other words, the generics prescribing ratio of the most popular anti-hypertensive medicines at a clinic was reversely associated with the urbanization level.

The data show that DHP generics are far less frequently prescribed at outpatient departments of hospitals than at physician clinics in Taiwan. Because most hospitals are located in urban areas, the authors’ analysis of physician clinics confirmed the urban-rural disparity of generics prescribing in Taiwan.

In most densely populated regions, generics prescribing ratios were the lowest. In contrast, generics prescribing was highest in the most sparsely populated area of eastern Taiwan. ‘The underlying causes, clinical consequences and economic justice of urban–rural disparity in prescribing generics deserve further investigation’, the authors conclude.

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References
1.   Hsu CC, Chou CL, Chiang SC, Chen TJ, Chou LF, Chou YC. Urban-rural disparity of generics prescription in Taiwan: the example of dihydropyridine derivatives. ScientificWorldJournal. 2014;2014:905213. doi:10.1155/2014/905213. eCollection 2014.
2.   GaBI Online – Generics and Biosimilars Initiative. The generics market in Taiwan [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2014 Oct 10]. Available from:www.gabionline.net/Reports/The-generics-market-in-Taiwan
3.   GaBI Online – Generics and Biosimilars Initiative. Taiwan too good to be true [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2014 Oct 10]. Available from: www.gabionline.net/Policies-Legislation/Taiwan-too-good-to-be-true