A qualitative study of pharmacists’ first experiences with the generic substitution of asthma and COPD inhalers in community pharmacies

Background Increasing pharmaceutical costs are a global concern in health care. Several countries have introduced generic substitution (GS) to contain the costs. Finland has expanded GS to include asthma and chronic obstructive pulmonary disease (COPD) inhalers, and pharmacists ensure the correct inhalation technique and safe medication management with the patients. Understanding and researching the legislative changes is crucial to assessing the outcomes of reforms and informing stakeholders who are planning similar initiatives. This study aims to study community pharmacists’ experiences with the implementation of the GS of asthma and COPD inhalers reform. Methods Thematic interviews with 20 pharmacists working in community pharmacies were conducted in the fall of 2023. The interviews were recorded, transcribed and analyzed with inductive and deductive content analysis by using NVivo software. The interviews were first encoded and categorized according to the interview framework. The data were revisited several times, and final data were analyzed with respect to five themes. The COREQ checklist was followed in reporting the study. Results The pharmacists considered the GS of asthma and COPD inhalers to be natural for them, mainly because GS of other medicines has been a familiar practice for decades. Pharmacists reflected that the patients had reacted to the GS of asthma and COPD inhalers similarly to how they react to substitutions of other medicines. Patient counseling on inhalers has been straightforward, due to there being only minor technical differences between inhalers. The obligation to provide patient counseling on inhalers is specifically fulfilled when a patient purchases an inhaler for the first time, when the prescription is new, or when the inhaler is being substituted. Cooperation between pharmacies and health care regarding the GS of asthma and COPD inhalers has been minimal. The pharmacists felt well-informed about the reform and its implementation, even with limited additional training. Conclusions The GS of asthma and COPD inhalers reform has been successful from the perspective of pharmacists working in community pharmacies. Pharmacists’ obligation to provide patient counseling on inhalers to ensure safe medication management is well implemented. To our knowledge, this is the first study on experiences with generic substitution of inhalation products and, therefore, provides invaluable information for stakeholders planning similar reforms.