Interpretation of research results
This study analyzes how sales patterns in Korea differ from those in other countries, including the market share and growth rate of original drugs, from the first to the fifth year after the first generic drug is launched.
First, it is observed that generic drugs are actively challenging oral drugs. The period between the approval of the original drug and the first generic drug in the group with generic drugs tends to be shorter than the average of 47.1 quarters (141 months) in the study conducted in Korea [22] and 12.9 years [27] and 13.6 years [28] in the study conducted in the US. This implies that generic drugs prepare to enter the market as quickly as possible to take the lead, considering the patent expiration time of the original drug.
An average of 24.7 generic drugs were approved per original drug, and there was an original drug with even 142 generic drugs launched. Compared with that of previous research, which reported an average of 20 generics launched in Germany [33] and an average of 15.2 in Korea [23], the number of generic drugs launched indicates a higher result. This is similar to the results of a study [26] that reported that the number of blockbuster drugs first exposed to generic competition in the US has increased several times since 2002. In addition, according to a report [10] that used data from HIRA, the number of drugs covered by insurance increased by 44.5% from June 2013 to June 2016 after the new drug price system was introduced in 2012, and the number of generic drugs for high-selling off-patent original drugs has increased by two to even ten times compared with that of in 2012. This trend in Korea aligns with the increasing trend in the number of generic drugs launched for this study drugs.
Moreover, the product sales and market size of the group with generic drugs are larger than those of the group without generic drugs. This finding is similar to a study about the US [26], which stated that the main reason for the absence of generic competition is economic factors (small sales of branded products in the year immediately before patent expiration). In this study, if the product sales and the market size are larger, it implies that the launch of generic drugs is active.
Second, the market share of 48 original drugs fell the most at 89% in Q4, as the price is reduced to 70% in the first year of generic drugs launched under Korea’s drug price system [35]. When three or more generic drugs are launched, the price is lowered to 53.55%—the same as that of generic drugs in the second year. The decline began to slow slightly from the third year. Research about drugs that experienced the first generic entry in 2011-2012 and 2013-2014 in the US revealed that brand sales decreased sharply after generic entry, with the average brand share in the first year being 16% [27] and 12% [28], respectively. In European countries, the market share of generic drugs ranged from 17% in Switzerland to 83% in the United Kingdom, and in the US, the usage rate of generic drugs was as high as 84% in 2013 [7]. The market share of the 48 drugs in this study differs from that of overseas countries.
A review of studies [22, 23] on Korea revealed that the market share of generic drugs is mainly reported; therefore, the market share of the original drug must be inferred from these data. Further, the market share of generic drugs would converge to an average of 53% [22] and 39.35% [23] in the long run. Based on these results, the market share of original drugs is 47% and 60.65%; thus, the market share of the 48 study drugs in Q20 is higher than theirs. Existing studies [22, 23] used function estimation results to infer long-term market share, but this study measured market share over consecutive periods using empirical data. In the previous study [23], the first- and second-year market shares of original drugs, which were measured using actual data, were 78.98% and 69.53%, respectively. Therefore, the market share of the 48 study drugs is higher than that reported by previous research.
Despite the price cut, the value growth rate was maintained, and continuous growth in volume was observed, demonstrating a different pattern from that in overseas countries, where original drugs whose patents have expired are gradually disappearing from the market. Comparisons are difficult as there are no existing studies on the growth rate of individual products, but these results indicate that Korea’s off-patent original drugs are experiencing considerable growth.
Third, we analyzed the difference between the categories for three attributes of 48 original drugs. The market share of the J and L groups was consistently high without experiencing a sharp decrease for five years. It is similar to the research results [23] which reported that the market share of generic drugs is estimated to converge to 65.30% and 9.08% in the long run for ATC codes C (cardiovascular system) and L (antitumor drugs and immunomodulators), respectively, and in case of ATC code C, the use of generic drugs is active and market competition is fierce, but in case of ATC code L the proportion of new patients using generic drugs or replacing existing original drugs with generic drugs is quite low.
The market share of injections experienced a gradual decline for up to two years but had a rapid decline in the fifth year. This is consistent with research which found that difficulties in production techniques act as an entry barrier for injections [13] and that the timing of entry of generic drugs for injections is delayed compared with oral drugs [14].
In the analysis by the number of generic drugs, the slope of the market share tends to be lower than that of groups with 1 to less than 10 generic drugs, except for 1 group. Although the purposes of the analysis are different, to some extent, this aligns with research which revealed that in the US, the market share of an original drug is inversely proportional to the number of generic drugs [30]. Additionally, research has revealed that the greater the number of generic drugs in Korea, the higher the market share of generic drugs [20]. Another research reported that the greater the number of generic drugs, the significantly lower the market share of the first listed drugs in Korea [12].
In the analysis by sales value of original drugs, compared with the group with less than KRW 5 billion (the smallest sales group), the slope of the market share tends to be lower in groups with large sales except for one group, although it is not significant. However, there is still insufficient evidence that the market share of original drugs is small in groups with large sales of original drugs before the launch of generic drugs, which is similar to research about Korea [19].
In the analysis by market size, compared with the group with sales of less than KRW 50 billion, the slope of the market share tends to be numerically low in the groups with larger market size, but it is not significant. In the two studies about Korea, it was found that the larger the market size, the more intense the market competition in the third year, but there was no statistically significant difference [13]. Additionally, the larger the market size, the more likely the production scale of generic drugs will be large, but the market share was not affected by the market size [20]. In Korea, there is still insufficient evidence that when the market size before the launch of a generic drug is large, the market share of the original drug will be small due to active competition from generic drugs.
Background on sales patterns of off-patent original drugs in Korea
The main reasons why the sales pattern of off-patent original drugs in Korea differs from that of other countries are the drug price system [2-5] and policies [1, 6, 15-17], such as the generic drug prescription activation system, where it is currently not mandatory to prescribe drugs by their generic name in Korea.
First, according to the drug price system that has been implemented in Korea since 2012, the same price is given to drugs with the same ingredient in principle, and after one year, the price of the original drug become 53.55% of the price before the launch of the generic drug and is the same as that of the generic drugs [35]. However, the prices of generic drugs are set lower than those of original drugs in European countries, and, generally, generic drugs adopt a cost advantage strategy [33]. However, in Korea, there are cases where the price of the original drug is even lower [19], the cost advantage strategy is rather implemented by the original drug as it has been on the market for many years and can guarantee quality.
A study analyzing the impact of the new drug price policy introduced in Korea in 2012 found that the system was more favorable to original drugs than generic drugs [16]. It reported that although they successfully responded to Korea’s ever-increasing drug costs, the impact was temporary and the policy effect was inefficient and unsustainable due to a lack of demand-side measures [17].
In addition, many countries encourage the use of generic drugs to achieve cost savings by using cheaper generic drugs compared with original drugs [7]. However, the annual savings from using generic drugs in Korea are very low because the price difference between original and generic drugs is small; the price difference among generic drugs is large; and high-priced generic drugs are preferred in the market [19]. Korea also has a policy to encourage alternative preparations, but a report indicates that the replacement rate for low-cost drugs is only 0.2% [1].
In Korea, both off-patent original drugs and generic drugs are growing simultaneously under the current system, so it cannot be said that the prescription of generic drugs is being encouraged. Therefore, the sales pattern of original drugs differs and continues to grow even after patent expiration, depending on how they are promoted to doctors who can prescribe them.
Pharmaceutical companies that sell original drugs sometimes adopt differentiation strategies, including ways to improve efficacy, safety, and stability or by developing new substances, new formulations, combination drugs, and new indications [9,45-46]. In particular, multinational pharmaceutical companies in Korea engage in patent litigation as a defense strategy [9,45-49], and they actively conduct clinical trials even for off-patent drugs to develop promotional messages.
Limitations of this study and future research
The limitation of this study is that the individual drug price changes of original drugs, the results of patent disputes, and the promotion activities of original drugs during the research period were not analyzed as influential factors on sales patterns. Future research should consider the following: First, competition should be analyzed with original drugs containing different ingredients in the ATC Level 4 market after patent expiration. Second, analysis should be conducted according to the product strategy type and ratio of promotional activity costs. Third, sales patterns should be analyzed according to the share of the sales of off-patent original drugs in a company.