ABSTRACT
The introduction of generic medicines in the 1990s has changed the structure and functioning of the French pharmaceutical market. While these cheaper copies of medicines whose patents have expired were virtually absent from the market in the early 1990s, they now account for almost one in three medicines sold in France. The country still lags behind many of its European neighbors, where generics account for more than eight out of every ten medicines sold. To explain this French “lag”, this chapter analyzes the strategies developed by pharmaceutical companies to guide prescriptions (issued by doctors and filled by pharmacists) and thus control the market. The introduction of the right to substitute (authorizing pharmacists to substitute a generic medicine for the original/princeps medicine when possible) in 1999 made pharmacists the main promoters of generic medicines and the main customers of generic companies. But pharmacists’ right to substitute has at the same time reinforced the role of physicians, who have the power to stop the substitution or divert it by prescribing the patented original instead of old “genericized” medicines, and who are encouraged by original drug companies to do so. In order to influence prescribers, manufacturers obviously intend to play on the particular interests of these health professionals (remuneration, professional status, control over prescription, and so on) but also on their representations of the general interest (public health, public finances, research and development) and how best to serve it. The analysis draws both on interviews conducted with the different market actors and on statistical analyses of the market shares of medicines. It ultimately shows how the competition between original and generic medicines is therefore not so much a price competition as a struggle for influence over health professionals.
