Reflecting on My Master’s Thesis: The Impact of Lebanon’s Generic Drug Substitution Policy
In 2015, as part of my Master’s degree at Universitat Pompeu Fabra – Barcelona, I carried out one of the earliest evaluations of Lebanon’s newly enacted Generic Drug Substitution Policy. This policy was meant to encourage physicians and pharmacists to prescribe and dispense more affordable generics, with the hope of reducing Lebanon’s growing pharmaceutical expenditure.
At the time, Lebanon was (and still is) a brand-oriented pharmaceutical market. Out-of-pocket spending on medicines was high, and households were shouldering a disproportionate share of health costs. Generics represented an opportunity to relieve some of this burden.
Key Findings from My Thesis
Over a two-month study period, I analyzed 737 standardized prescriptions filled at a strategically located pharmacy in Beirut. The findings highlighted systemic challenges that still resonate today.
Physicians remained the dominant actors in prescribing: in fact, 67% of prescriptions were marked “Non-substitutable,” leaving pharmacists with little room to intervene. This translated directly into low uptake of generics. Despite global evidence that wider use of generics can reduce drug expenditure by 30% or more, 78% of medications dispensed were originator brands, while only 22% were generics.
Even when substitution was theoretically possible, the opportunity was not seized. Roughly one-third of prescriptions were marked as substitutable, yet not a single medication was actually switched to a cheaper alternative. Ironically, by reinforcing physician control through the prescription form, the policy had the opposite effect of what was intended: it effectively reduced generic substitution at the pharmacy level.
Why This Research Still Matters
Lebanon’s healthcare system continues to face financial strain, rising drug costs, and inequities in access. The issues I studied nearly a decade ago remain highly relevant. Policies need to balance physician autonomy with cost-effective prescribing, while electronic prescribing and dispensing systems would bring much-needed transparency and better data collection. Cost-sharing mechanisms could also incentivize both patients and prescribers to take generics more seriously. Above all, sustainable change requires trust-building — physicians and patients alike must feel confident in the quality and reliability of generic medicines.
From Research to Broader Practice
This thesis was more than an academic milestone. It shaped my professional perspective on health financing, pharmaceutical policy, and healthcare reform. Since then, I’ve worked on designing Business Intelligence tools for pharmacy claims, analyzing utilization trends, and supporting healthcare decision-makers with actionable insights.
Looking back, this early research reinforced my belief that health policy is not just about laws on paper — it’s about behavioral change, system design, and incentives.
✍️ Written by Amal El Kabbout — bridging pharmacy, health economics, and strategy in the Middle East.
