[Inside Chodong]Will Prescribing by Generic Name Guarantee Consumer Choice?

Just as the chaotic medical field seemed to be returning to normal, tensions are now rising between doctors and pharmacists over the issue of prescribing medications by their generic names. Medical associations are fiercely opposing the “Pharmacists Act Amendment” and the “Medical Act Amendment” proposed by Assemblyman Jang Jongtae of the Democratic Party of Korea and others, threatening to mobilize all possible means of protest, including demonstrations outside the National Assembly.

Prescribing by generic name is a system in which doctors specify only the active ingredient of a medication, rather than its brand name, allowing pharmacists to choose from various generic drugs containing the same ingredient when dispensing. For example, instead of writing the brand name “Tylenol” on a prescription, the doctor would prescribe the ingredient “acetaminophen.”

The medical community argues that this infringes on the right to make clinical decisions and raises issues of responsibility. From a doctor’s perspective, medications from specific pharmaceutical companies are chosen after considering the patient’s condition, medical history, and the potential for side effects. If prescribing by generic name becomes mandatory, the responsibility for selecting the medication effectively shifts to the pharmacist. Even if generics are recognized as having the same efficacy, differences in quality or variations in formulation and excipients can lead to different patient responses, ultimately putting patients at a disadvantage.

On the other hand, pharmacists argue that being able to recommend the most suitable product among several drugs with the same ingredient for each patient could lead to lower drug prices through competition. In several European countries, mandatory prescribing by generic name and dispensing of the lowest-priced drugs have been reported to reduce the burden on national healthcare budgets. This approach could achieve two goals at once: strengthening patient choice and reducing pharmaceutical expenditures.

The government emphasizes the need to introduce prescribing by generic name as a way to address instability in the supply of medicines. A typical example is the recurring shortages of cold medicines, antipyretics, and Tamiflu during outbreaks of COVID-19 or influenza. The government believes that preventing prescriptions from being concentrated on specific drugs and utilizing generics can help resolve supply shortages. By encouraging the use of generics with the same active ingredient, increased price competition could lower drug prices, which in turn would stabilize the national health insurance budget.

However, while doctors, pharmacists, and the government each claim to be acting “for the benefit of patients” in arguing for or against prescribing by generic name, the perspective of patients-the actual consumers of healthcare-has been largely overlooked. Most patients are unfamiliar with both drug names and generic names, and have difficulty accessing essential information such as safety, ease of use, or manufacturer reliability. As a result, patients are likely to insist on the original brand-name drugs they have previously taken or simply rely on the pharmacist’s recommendation. It is questionable whether patients, when ill, would choose cheaper drugs simply by comparing prices. Furthermore, in Korea, the price difference between original and generic drugs is not significant, and the efficacy of generics recognized as having the same active ingredient can range from 80% to 120%. There is also the possibility that illegal pharmaceutical rebates, which have previously occurred between hospitals and pharmaceutical companies, could shift to pharmacies.

Ultimately, the purpose of introducing prescribing by generic name must be clearly defined, and institutional measures must first be established to enable patients to make rational and safe choices about the medications they take. If the goal is to reduce excessive national pharmaceutical expenditures, the priority should be to address fundamental issues such as restructuring the pharmaceutical industry or improving the drug pricing system, rather than changing prescription methods. A system that increases patient confusion and creates unnecessary conflict between doctors and pharmacists could ultimately threaten public health and do more harm than good.