Pharmacy dispensing patterns and out of pocket expenditure to the patient for generic prescriptions of psychotropic medicines: a survey from 5 locations in Sri Lanka

Background: A crucial element that restricts access to medicines is price. Generic drugs provide the opportunity for major savings in out of pocket healthcare expenditure since they may be substantially lower in price. However when a generic drug is prescribed, pharmacist decides which brand of the drug to be dispensed. This results in patients paying for single drug at markedly different prices. Aims: To compare costs patient has to bear for psychotropic drugs fluoxetine and risperidone when a generic prescription is presented to a pharmacy. Methods: Pharmacies in 5 urban locations (Kurunegala, Kandy, Anuradhapura, Puttalam, Mahiyangana) in Sri Lanka were evaluated. A generic prescription for Fluoxetine 20 mg and Risperidone 2mg was presented to retail pharmacies and received medications were analyzed for the specific brands dispensed and costs incurred. Results: Price of a fluoxetine 20mg capsule ranged from Rs. 1.72 to Rs. 30.00 and price of risperidone 2mg tablet was from Rs 1.15 to Rs. 23.00. Combined monthly cost for the medications ranged from Rs 86.10 to Rs 1803.00. Approximately 80% prescriptions received brand preparations expensive than the cheapest brand among them. Lowest cost risperidone was dispensed only in 18% of instances. Lowest cost fluoxetine was dispensed only in 24% of instances.