KNOWLEDGE, ATTITUDE, AND PRACTICES OF PHARMACISTS REGARDING UTILISATION OF GENERIC MEDICINES IN JAIPUR

KNOWLEDGE, ATTITUDE, AND PRACTICES OF PHARMACISTS REGARDING UTILISATION OF GENERIC MEDICINES IN JAIPUR

Tanisha Khandelwal * and Pooja Choraria

I. I. S. Deemed to be University, Jaipur, Rajasthan, India.

ABSTRACT: Objective: Government initiatives such as the Pradhan Mantri Jan Arogya Yojana (PM-JAY) under the Ayushman Bharat scheme have sought to expand access to healthcare, including the promotion of generics. Pharmacists, as primary intermediaries between manufacturers and consumers, play a crucial role in shaping public perceptions and promoting the uptake of generic medicines. This study aims to investigate pharmacists' knowledge, attitudes, and practices regarding the utilisation of generic medicines in Jaipur. Methodology:  A sample of 100 pharmacists was studied in Jaipur city. Descriptive analysis was performed using mean, standard deviation, frequency, and percentage for data representation. The Mann-Whitney U and Kruskal-Wallis tests assessed the significance of categorical variables, with p<0.05 considered statistically significant. Results: The data show high awareness of generic medicines among medical professionals, with knowledge increasing with age and experience. Older professionals (above 45) and those with over 20 years of experience have significantly higher knowledge scores. Attitudes toward generics are generally positive, though younger professionals and those with less experience show slightly less favourable views. About 60% dispense fewer than 25% generics, revealing a gap between knowledge and practice. Professionals with 6–20 years of experience demonstrate better practices in encouraging and substituting generics. Conclusions: Despite strong support, concerns about quality, counterfeit medicines, and socio-economic factors influence substitution practices. Efforts to standardize guidelines and build confidence, especially among younger professionals, are needed to bridge the gap between knowledge and practice.

Keywords: Generic medicines, Bioequivalence, Substitution, Pharmacists, Jan Aushadhi scheme

INTRODUCTION: Access to affordable healthcare remains a challenge in India, where out-of-pocket expenditure is significantly high compared to the global average ⁴. Although generic medicines offer bioequivalent and cost-effective alternatives to branded drugs ^5-7, their acceptance and utilisation remain inconsistent. Concerns about quality, variable perceptions among healthcare providers, and limited patient awareness continue to restrict their wider adoption.

Pharmacists play a crucial role in medication counselling and substitution; however, studies across India report mixed levels of knowledge and uncertainty regarding therapeutic equivalence, partly due to inadequate training and unclear policy direction ^1-3. Evidence specific to Rajasthan particularly Jaipur remains limited, leaving a gap in understanding how local pharmacists perceive, recommend, and dispense generic medicines.

Government initiatives like the Pradhan Mantri Bharatiya Jan Arogya Yojana (PM-BJAY) and the Jan Aushadhi Yojana aim to improve access to healthcare and encourage the use of generics. Launched in 2018, PM-BJAY covers over 540 million people and provides cashless treatment, with Jan Aushadhi Kendras (JAKs) offering affordable medicines across India.

In Rajasthan, 440 JAKs operate, including 130 in Jaipur, contributing to greater access to generics ⁹. Therefore, this study aims to assess the knowledge, attitudes, and practices of pharmacists in Jaipur regarding generic medicines, examine the influence of national initiatives on their dispensing behaviour, and identify barriers hindering the effective promotion of generics. The findings will support efforts to strengthen generic medicine uptake and improve healthcare affordability in India.

Literature Review: This review traces the evolution of literature on pharmacists’ Knowledge, Attitude, and Practices (KAP) toward generic medicines from 2009 to 2024, highlighting progress, challenges, and persistent gaps.

2009–2013: Early Knowledge Gaps: Studies during this period showed that pharmacists were beginning to adopt more patient-centred roles, yet misconceptions about the efficacy and safety of generic medicines persisted. Limited training on bioequivalence and regulatory standards reduced pharmacists’ confidence in substituting branded medicines with generics ^1–3.

2014–2018: Persistent Attitudinal and Communication Barriers: Between 2014 and 2018, research demonstrated that doubts about generic quality and therapeutic equivalence remained common among pharmacists and patients ⁴. International studies also highlighted the influence of misinformation, poor pharmacist–prescriber communication, and limited recognition of pharmacists’ roles in promoting generics ^{5, 6}.

2019–2021: Practice-Level Constraints: Studies from 2019–2021 reported improved understanding of generics’ cost benefits but continued hesitation regarding therapeutic equivalence. Dispensing patterns were influenced by prescriber preference, patient expectations, brand familiarity, and supply inconsistencies. Pharmacists also noted reduced autonomy in substitution decisions ^{7, 8}.

2022–2024: Policy Implementation and Systemic Challenges: Recent evaluations of PMBJP and Ayushman Bharat indicated strong pharmacist support for affordable generics but persistent challenges such as inconsistent stock availability, low public awareness, and supply chain gaps ⁹.

Research from 2023–2024 highlighted discrepancies between academic knowledge and community practice and noted better uptake of generics in regions with structured pharmacist training and clearer substitution guidelines, although prescriber scepticism and systemic inefficiencies remain major barriers ^{10, 11}. Overall, the literature shows a progression from foundational knowledge gaps (2009–2013) to attitudinal barriers (2014–2018), practice constraints (2019–2021), and system-level challenges (2022–2024). Strengthening pharmacist training, improving supply reliability, enhancing patient awareness, and fostering interdisciplinary collaboration are critical for advancing generic medicine adoption in India.

MATERIALS AND METHODS: A cross-sectional descriptive study was conducted among pharmacists in Jaipur, Rajasthan, to assess their knowledge, attitudes, and practices regarding generic medicines. The sample size was calculated using the formula

n = Z²p (1 - p) / e²

With Z = 1.96, p = 0.5, and e = 0.10, yielding a minimum of 97 participants. To enhance reliability, 100 pharmacists were included. A convenience sampling technique was used to select pharmacists who were available and willing to participate at community and hospital pharmacies across Jaipur. Registered pharmacists working in community or hospital pharmacies with a minimum of six months of professional experience were included in the study. Interns or students without active registration or unregistered pharmacy staff were not considered for the study. Data were collected using a structured, pre-tested questionnaire covering demographics, knowledge, attitude, and dispensing practices. Face-to-face interviews ensured clarity and completeness. Responses were coded dichotomously (1 = positive, 0 = negative), and composite KAP scores were computed. Descriptive statistics, Mann–Whitney U, and Kruskal–Wallis tests were applied using SPSS, with significance set at p < 0.05.

Ethics Approval: Ethical approval was obtained from the Institutional Ethics Committee. Written informed consent was obtained from all participants.

RESULTS:

TABLE 1: DEMOGRAPHIC CHARACTERISTICS OF PHARMACISTS (N=100)

A majority of respondents fall within the 25–35 years age group (49%) and have 0–5 years (36%) or 6–10 years (31%) of experience. Most (68%) are associated with private medical facilities Table 1.

FIG. 1: BAR CHART FOR AGE GROUP OF PHARMACISTS                                     

FIG. 2: PIE CHART FOR YEARS OF EXPERIENCE OF PHARMACISTS

TABLE 2: KNOWLEDGE OF PHARMACISTS ABOUT GENERIC MEDICINES (N=100)

Awareness of generic medicines is universal (100%), and most pharmacists know they contain the same active ingredient (88%) and meet regulatory standards set by CDSCO (75–88%). Fewer, however, recognise full therapeutic equivalence (72%). Some concerns persist, with 34% viewing generics as less effective, 85% worried about counterfeits, 39% about competition affecting quality, and 29% about price-control impacts. Awareness of the Jan Aushadhi scheme is also universal (100%), and while 77% report higher sales of branded drugs, 79% believe wider use of generics can reduce government healthcare expenditure Table 2.

TABLE 3: ATTITUDE OF PHARMACISTS ABOUT GENERIC MEDICINES (N=100)

Most pharmacists support generic substitution (86%) and believe they should be legally required to recommend it (85%). Few consider generics inferior or produced in lower-quality facilities (15–16%). While Jan Aushadhi is viewed as an effective promoter of generics (100%), it is also seen as a source of conflict with physicians and patients (100%). Many fear that substituting branded drugs may harm professional relationships (71%), though none fear therapeutic failure Table 3.

TABLE 4: PRACTICE OF PHARMACISTS ABOUT GENERIC MEDICINES (N=100)

Most pharmacists (86%) have recommended generics, but only 29% routinely promote them when branded drugs are prescribed. Generics make up less than 25% of dispensed medicines for the majority (60%). Nearly all pharmacists (99%) want standardized substitution guidelines, and 70% remain cautious when substituting. Most encourage patients to choose generics and use them personally (both 85%). Socioeconomic status strongly influences dispensing decisions (99%), and pharmacists recognize their impact on patient choices (99%). Confidence in generic quality is high (84%), with only a small proportion (7%) reporting minor concerns related to effectiveness, appearance, or availability Table 4.

TABLE 5: EVALUATION OF KAP SCORES IN STUDY POPULATION (N=100)

The knowledge score (mean 13.38 ± 1.25) indicates a strong understanding, with a median of 14. The attitude score (mean 6.42 ± 0.74) shows moderate positivity, with a median of 7. The practice score (mean 7.43 ± 1.31) reflects moderate application, with a median of 8, suggesting variability in practice despite high knowledge and positive attitudes Table 5.

TABLE 6: COMPARISON OF KAP SCORES OF PHARMACISTS ABOUT GENERIC MEDICINES BETWEEN DEMOGRAPHIC VARIABLES (N=100)

Pharmacists’ knowledge, attitude, and practice (KAP) scores increased steadily with both age and years of experience. Younger pharmacists (<25 years) and those with 0–5 years of experience had the lowest scores across all domains, while those above 45 years or with more than 20 years of experience showed the highest knowledge and consistently strong attitude and practice scores. All associations between age, experience, and KAP scores were statistically significant (p < 0.001), indicating that greater professional exposure and maturity are strongly associated with a better understanding and use of generic medicines Table 6.

FIG. 3: BOX PLOT FOR AGE GROUP V/S KAP SCORES OF PHARMACISTS ABOUT GENERIC MEDICINES

FIG. 4: BOX PLOT FOR YEARS OF EXPERIENCE V/S KAP SCORES OF PHARMACISTS ABOUT GENERIC MEDICINES

CONCLUSION: This study demonstrates that pharmacists in Jaipur possess strong knowledge and generally positive attitudes toward generic medicines, yet their real-world dispensing practices remain limited.

Although awareness of cost benefits and regulatory standards is great, concerns about quality, prescriber influence, and supply inconsistencies hinder routine substitution. Age and experience significantly enhance KAP scores, suggesting that practical exposure and professional maturity contribute to greater confidence in recommending generics.

Despite widespread support for initiatives like Jan Aushadhi, pharmacists continue to face relational and systemic barriers that restrict full adoption. Strengthening substitution guidelines, improving quality assurance communication, and providing targeted training particularly for early-career pharmacists may help translate positive perceptions into consistent practice. Addressing these gaps is essential for maximising pharmacists’ contributions to affordable healthcare and expanding the use of generic medicines in India.

DISCUSSION: This study highlights a clear gap between pharmacists’ knowledge and attitudes toward generic medicines and their actual dispensing practices in Jaipur. Although awareness of the economic advantages of generics was high, hesitancy in routine substitution reflects persistent concerns about product quality, regulatory consistency, and supply reliability. Similar patterns have been documented in earlier Indian and international studies, indicating that knowledge alone does not drive practice unless supported by trust, experience, and system-level reinforcement ^{10, 11, 14, 15}. The positive association between higher experience and better KAP scores aligns with previous findings suggesting that seasoned pharmacists develop greater confidence through prolonged exposure to patient care, prescriber interactions, and evolving pharmaceutical policies ^{12, 17}.

Younger pharmacists may be more susceptible to prescriber influence, commercial pressures, and uncertainty regarding substitution guidelines issues also noted in earlier research ^{18, 19}.

The influence of prescriber preference on pharmacists’ dispensing behaviour continues to be a major barrier, reflecting long-standing hierarchical dynamics in Indian healthcare. Without clear substitution policies or strengthened inter-professional communication, pharmacists often remain hesitant to promote generics despite supporting their use ^{6, 17, 22}.

These findings are particularly relevant to government programs such as PMJAY and PMBJP, where implementation challenges such as stock variability and limited public awareness have already been documented ^{9, 15, 18, 23, 24}.

The Jaipur findings reinforce that pharmacists are willing partners in expanding generic medicine use, but operational support, consistent supply, and regulatory clarity are essential to transform positive attitudes into practice.

Implications: This study reveals key barriers to pharmacists’ adoption of generic medicines, including quality concerns, inadequate substitution guidelines, limited training, supply issues, and prescriber influence. Addressing these challenges requires focused professional training, clearer regulatory direction, and stronger communication on bioequivalence standards. Improved supply chain management under PMBJP and PMJAY, together with better pharmacist–prescriber collaboration, can promote more consistent use of generics and support efforts to improve healthcare affordability.

ACKNOWLEDGEMENT: We gratefully acknowledge the support of the University for providing facilities and guidance to conduct this research. We sincerely thank all the pharmacists who participated in the study for their valuable time and insights.

CONFLICTS OF INTEREST: Nil

REFERENCES:

1. World Health Organization. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. Geneva: WHO 2010.
2. Mostafa S, Mohammad MA and Ebrahim J: Policies and practices catalyzing the use of generic medicines: a systematic search and review. Ethiop J Health Sci 2021; 31(1): 167-78. doi:10.4314/ejhs.v31i1.19.
3. Wong ZY, Alrasheedy AA, Hassali MA and Saleem F: Generic medicines in the Malaysian health care system: opportunities and challenges. Res Social Adm Pharm 2016; 12(5): 807-10.
4. World Health Organization. Drug information from WHO [Internet]. Geneva: WHO; 2021 Jun 8 [cited 2025 Sep 14]. Available from: http://www.who.int/medicines/publications/druginformation/WHO_DI_30_3_GenericMedicines.pdf
5. Dunne S, Shannon B, Dunne C and Cullen W: A review of the differences and similarities between generic drugs and their originator counterparts, including economic benefits associated with generic medicine usage, using Ireland as a case study. BMC Pharmacol Toxicol 2013; 14: 1. doi: 10.1186/2050-6511-14-1.
6. Madan S and Juyal SA: Influence of medical practitioners’ practice on the prescription behaviour for generic medicines. Environ Conserv J 2023; 12(4): 1275-92. doi:10.31838/ecb/2023.12.si4.115.
7. S. Food and Drug Administration. Generic drugs: questions & answers [Internet]. Silver Spring (MD): FDA; 2018 Dec 31 [cited 2025 Sep 14]. Available from: https://www.fda.gov/drugs/frequently-asked-questions-popular-topics/generic-drugs-questions-answers
8. European Medicines Agency. Questions and answers on generic medicines [Internet]. London: EMA; 2011 [cited 2015 Jun 21]. Available from: http://www.ema.europa.eu/docs/en_GB/document_library/Medicine_QA/2009/11/WC500012382.pdf
9. National Health Authority. About Pradhan Mantri Jan Arogya Yojana (PM-JAY) [Internet]. New Delhi: Government of India; [cited 2025 Jun 12]. Available from: https://nha.gov.in/PM-JAY
10. Basak SC, van Mil JW and Sathyanarayana D: The changing roles of pharmacists in community pharmacies: perception of reality in India. Pharm World Sci 2009; 31(6): 612-8. doi:10.1007/s11096-009-9307-y.
11. Basak S and Sathyanarayana D: Exploring knowledge and perceptions of generic medicines among drug retailers and community pharmacists. Indian J Pharm Sci 2012; 74(6): 571-5. doi:10.4103/0250-474X.110611.
12. Maddirala SV, Reddy SP, Kielgast P, Udhumansha U and Airaksinen M: Pharmacists in national public health programs in India: a pilot study highlighting physicians’ perceptions. J Young Pharm 2017; 9(1): 47-54. doi:10.5530/jyp.2017.9.10.
13. Mallam N, Rudraiah CSB and Rudraswamy S: Generic drugs: current status and future potential. J Generic Med 2017; 13(2): 54-9. doi:10.1177/1741134317691803.
14. Ballala K, Rao CR, Chaudhary AS, Bidnurmath AS and Pandey AK: Knowledge, attitude and practices regarding generic medicines and its usage: a community-based study. Int J Community Med Public Health 2019; 6(5): 2182-6. doi:10.18203/2394-6040.ijcmph20191841.
15. Pareek M and Prakash M: Providing generic medicines to the poor in India: an overall assessment of government-run generic medicine scheme Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) with reference to the experience of store owners in Jaipur [Internet]. Rochester (NY): SSRN; 2019 May 1 [cited 2025 Sep 14]. Available from: http://dx.doi.org/10.2139/ssrn.3382656
16. Patel K, Yasobant S, Charan J, Chaudhari M, Gaidhane A and Saxena D: Acceptability and perceptions of generic drugs among patients, pharmacists, and physicians. J Pharm Res Int 2020; 32(33): 40-7. doi:10.9734/jpri/2020/v32i3330948.
17. Gupta VK, Singh A, Gupta AK, Trigunayat A and Kumar B: A pilot study on knowledge and experience on use of generic medicines among healthcare professionals. Res J Pharm Technol 2022; 15(12): 5807-11. doi:10.52711/0974-360X.2022.00980.
18. Study of perception and use of generic medicine with special reference to Pradhan Mantri Bharatiya Janaushadhi Pariyojana. J Pharm Negative Results 2022; 13(9): 2536-44. doi:10.47750/pnr.2022.13.S09.301.
19. Suthar J and Patel S: A comparison of pharmacy students’ and community pharmacists’ knowledge, attitude, and practice of generic vs branded medicines. J Med Res Rev 2023; 1(1): 36. doi:10.5455/JMRR.20230908033552.
20. Joshi NSCS: Factors impacting preference to generic medicines in India. Tuijin Jishu/J Propuls Technol 2023; 44(3): 2496-502. doi:10.52783/tjjpt.v44.i3.731.
21. Jain VM: Generic drugs & its future in India. Times of India Voices [Internet]. 2023 Mar 2 [cited 2025 Sep 14]. Available from: https://timesofindia.indiatimes.com/blogs/voices/generic-drugs-its-future-in-india/
22. Madan S and Juyal SA: Influence of medical practitioners’ attitude on the prescription behaviour for generic medicines. J Health Manag 2024; 26(1): 154-63. doi:10.1177/09720634231225015.
23. Sivarchaka O and Mamgain H: Transforming lives through Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY): a review. Natl Board Examin J Med Sci. 2024; 2(7): 730-42. doi:10.61770/NBEJMS.2024.v02.i07.010.
24. Verma ND and Pant NJ: An evaluation of state-wise implementation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in India. EPRA Int J Multidiscip Res 2024; 10(5): 442-8. doi:10.36713/epra17514.
    

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    How to cite this article:

    Khandelwal T and Choraria P: Knowledge, attitude, and practices of pharmacists regarding utilisation of generic medicines in Jaipur. Int J Pharm Sci & Res 2026; 17(4): 1320-27. doi: 10.13040/IJPSR.0975-8232.17(4).1320-27.

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