**4. Perceptions and adoption of generics**

Though generic medicines have been available for several decades, there is paucity of knowledge about what these medicines are and how these differ from their innovator counterparts. There is also a lack of understanding about the standards described for the approval and market authorization of generics and how these drugs have a lower cost [19].

There are lacunae in knowledge about generics in physicians, healthcare professionals, and patients. This is evident in the perceptions that healthcare professionals and patients have for generics and biosimilars. These perceptions drive the apathy or antipathy for generics and impact the adoption of generics in routine practice. There are mixed perceptions regarding the use of generic medicines. The perceptions differ in various countries. While physicians in the high-income countries generally have positive perceptions for generics, those in the low-income countries generally have more negative perceptions [12, 20]. Controversies have emerged regarding the adoption of generics for brand substitution [21]. The differences in perceptions can be attributed to various factors including the regulatory milieu, healthcare policies, educational initiatives, and drug information sources.

Perceptions regarding generics and biosimilars and attitudes of physicians, healthcare providers, and patients impact the use of generics (**Figure 1**). Several factors may impact the acceptance and use of generics. These factors are diverse and include increased knowledge about the regulated approval of generics and biosimilars and the increased awareness regarding generics from the access to information in social and scientific platforms.

Perceptions and levers for adoption of generics may be grouped into four broad categories (**Figure 2**).
