Impact of Switching from Brandedto Generic Medications on PatientAcceptance and Adherence inSaudi Arabia

Abstract

Introduction: The rising cost of pharmaceuticals has led to the increased use of generic medications as a more
affordable alternative to branded medications. Despite being bioequivalent and interchangeable with branded
counterparts, people remain suspicious about generic medications’ safety, efficacy, and general quality. Previous
research investigations have shown conflicting results: while some demonstrate cost savings and comparable
effectiveness, others indicate decreased adherence, misunderstandings, and inadequate clinical outcomes in sensitive
therapeutic areas. Although largely positive beliefs in Saudi Arabia, knowledge and trust gaps persist, emphasizing the
need for additional research into the factors driving generic acceptance and adherence. Objectives: This study aimed
to evaluate patient acceptance of switching from branded to generic medications and to assess treatment adherence
post-switch in the Saudi Arabian population. Materials and Methods: In Saudi Arabia, this cross-sectional study was
conducted from July to December 2025. Using Raosoft, a minimum sample size of 384 individuals was determined
with a 95% confidence level and a 5% margin of error. Participants who had switched from branded to generic drugs
within the previous 12 months and were at least 18 years old were eligible. The Medication Adherence Report Scale
(MARS)-5 was used to measure medication adherence, sociodemographic, clinical history, and attitudes toward
generic medications. The questionnaire was structured and self-administered, and it was derived from established
methods. Results: A total of 492 participants were analyzed (mean age 30.2 ± 12.5 years); 69.1% were female, and
64.2% were aged 18–30 years. Pharmacists most commonly initiated the switch (63.6%), and 87.8% reported being
informed that the medication was a generic equivalent. Most participants perceived generics as equally effective as
branded medicines (58.5%) and equally safe (66.1%); 54.1% trusted generic quality, and 37.4% trusted it “somewhat.”
Despite this, 63.0% preferred remaining on the branded medication if cost was not an issue; leading concerns were side
effects (33.1%) and reduced effectiveness (27.4%). Perception scores were mainly moderate (49.0%) or low (40.4%).
The mean MARS-5 score was 15.9 ± 4.9, with low adherence most prevalent (44.7%), followed by moderate (36.4%)
and high (18.9%). Region of residence was associated with perception category (P < 0.001). The perception category
was associated with the adherence category
(P < 0.001) and the general health category
(P = 0.005). Conclusion: While perceived
effectiveness, safety, and quality of generic
medicines were generally favorable, conditional
acceptance and suboptimal adherence were
common after switching, supporting the need
for consistent patient counseling and follow-up
after brand-to-generic substitution.