Background: In Germany, about one fourth of all tablets are split before ingestion. Since April 2007, by German law, pharmacists are legally obligated to substitute a prescribed drug for a generic drug, provided the patients' health insurance company has made corresponding contracts with pharmaceutical companies (discount contracts). However, generic drugs may differ substantially in their splitting properties. Until now it is unknown how generic substitutions due to discount contracts will influence the prescribing quality with regard to tablet splitting.
Methods: The prescription data of 425 ambulatory patients with polymedication insured at the Allgemeine Ortskrankenkasse (AOK) were analyzed and their drugs switched according to current discount contracts.
Results: Altogether 24% of all tablets were split before ingestion. For 54% of these split tablets (182 of 335) existing discount contracts mandated generic substitution. In about 10% of the substitutions there was a chance of substituting a scored tablet for a dosage form not suitable for splitting (unscored tablet or capsule).
Background: Therefore, current legislation should not only aim at reducing medication cost but also safeguard both effectiveness of the drugs and handling by the patients.