In Jamaica, the 1993 amendment to the Pharmacy Act allows pharmacists to offer patients generic substitutions for innovator brands; however, there were reservations among physicians about this policy implementation. The success of the amendment may be influenced by the confidence of physicians in the therapeutic equivalence of generics, especially since the act also allows physicians to indicate "no substitution" on prescriptions. The aim of this investigation was to examine the current attitudes of physicians towards the use of generic substitutions. One hundred questionnaires were distributed island-wide among physicians of varying specialities, with items to characterize their demographics and specific statements to determine their perception of generics. Sixty questionnaires were returned completed (60% response). Most of the responding physicians were males (2:1 male:female ratio); the majority were general/family medicine physicians in private practice. Forty-nine per cent of the responding physicians were mostly prescribing generic brands willingly, indicating that the cheaper cost of generic substitutes was a significant factor for this trend. There were doubts about whether bioequivalence of a generic was equitable to therapeutic equivalence to innovator drug. Additionally, 33% of the physicians were able to identify at least one case in the past year of clinical problems with generic substitutes that they perceived would not have occurred with the innovator. It is concluded that while the amendment to the Pharmacy Act encourages the substitution of generics in preference to innovator brands, more emphasis should be placed on improving physician confidence in the therapeutic equivalence of generics.