Boston—Pharmacists hear the complaints all of the time: Patients taking a generic equivalent drug are upset because their pills look different from what they usually get.

The FDA requires that generic drugs—which make up about 90% of dispensed prescriptions in the United States—have the same dosage form, strength, route of administration, intended use, quality, and performance characteristics as their brand-name versions. Generic drugs are not required to match their brand-name counterparts or each other in terms of physical appearance, including color, shape, size, and markings (text, lines, grooves, or designs). 

A report in the American Journal of Managed Care explains, “As a result, patients refilling a medication for a chronic disease may experience variations in their pills’ appearance when the generic manufacturer supplying a drug to a pharmacy changes.”

Unfortunately, according to researchers from Brigham and Women’s Hospital and Harvard Medical School, both in Boston, the odds of patients stopping or delaying essential drugs are increased when the appearance of pills changes. While past research has suggested that phenomenon, it is not clear why that occurs.

In an effort to answer the question, the study team conducted national surveys of patients and pharmacists regarding their preferences for, experiences with, and perceptions and responses to changes in generic drug appearance.

Included were patients aged 50 years and older taking generic drugs for depression, diabetes, epilepsy, HIV, hyperlipidemia, or hypertension, as well as licensed pharmacists practicing in chain, franchise, or independent pharmacies. Responses were collected between January and April 2016.

Among 1,000 patient respondents (30% response rate), the majority, 51%, reported experiencing changes in pill appearance and said they preferred to be notified about them (82%), yet less than half recalled being notified (verbally: 36%; via sticker: 45%). Among patients who reported experiencing a change, 12% reported stopping their medication or using it less frequently.

At the same time, among 710 pharmacist respondents (33% response rate), many reported changes in pill appearance occurring frequently in their pharmacies, with 47% reporting that changes occurred six or more times per month. Most pharmacists reported notifying patients about the changes verbally, 88%, or via sticker, 77%.

“Our findings reveal opportunities to improve patients’ experiences with pill appearance changes through better notification practices and patient education,” the authors conclude.

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