Consumer preference for generic medicines: associations with awareness, pharmacist recommendation, and cost-effectiveness

Background. Generic medicines provide an affordable substitute for branded medicines, but their use in Pakistan remains limited, mainly because of inadequate understanding, awareness, and advocacy at the pharmacy level. This study explored consumer perceptions, awareness, and preferences toward generic medicines and examined the factors associated with their acceptance. Methods. This descriptive cross-sectional study included 427 adult consumers recruited from community pharmacies across Karachi, Pakistan, between April and May 2025. Data were collected using a structured and validated questionnaire. Awareness, availability and recommendation by pharmacists (ARP), attitude, cost-effectiveness (CE), and preference toward generic medicines were recorded on five-point Likert scales. Results. Participants demonstrated generally high awareness regarding generic medicines (mean agreement 3.9 ± 0.7), although pharmacist guidance remained limited. Preference was positively correlated with awareness, ARP, and CE (r = 0.344, 0.332, and 0.495, respectively; p < 0.001), but negatively correlated with attitude toward branded medicines (r = −0.180; p < 0.01). The strongest factor associated with preference was cost-effectiveness (β = 0.444; p < 0.001), followed by awareness (β = 0.191; p < 0.001) and ARP (β = 0.158; p < 0.001), whereas stronger brand-favorable beliefs and skepticism toward generic medicines were associated with lower preference for generic medicines (β = −0.191; p < 0.001). Only 6.4% of the variance was explained by demographic predictors including gender, age, and income, compared with 37.3% explained by the attitudinal and perceptual model. Conclusion. Preference for generic medicines was strongly associated with awareness and perceived cost-effectiveness rather than demographic factors or pharmacist recommendations. Strengthening consumer education, promoting pharmacist-led counseling, and implementing public awareness campaigns could improve acceptance and utilization of generic medicines and contribute to more equitable access to affordable healthcare.