OBJECTIVES: High income groups in Pakistan resort to private healthcare settings for consultations and treatment modalities but only 5% of them have Social Health insurance coverage. As 77% of medicine expenditures are out-of-pocket payments in Pakistan, it is imperative to assess the understanding, perception, and attitude of this privileged group towards cost-effective alternatives. METHODS: In order to have an in depth evaluation of the issue qualitative methodology was adopted. A combination of purposive and snowball sampling was used to conduct face-to-face semi-structured interviews, which were then audio-taped, and transcribed verbatim. As sample size in qualitative research revolves around the attainment of point of saturation, no new themes emerged after the interview of 8 respondents.   RESULTS: Thematic content analysis identified four major themes; appropriate knowledge of generic medicines, negative perception towards generic medicines, negative attitude towards generic medicines, and future recommendations which should be directed towards the maintenance of quality and efficacy of generic alternatives. Interestingly, all the respondents managed to explain generic medicines with reference to patent expiry.  Regarding perception all of them expressed negative views and considered quality and safety as questionable domains in generic medicines. All the respondents cited negative concerns towards generic medicine utilization and harbored the notion that ‘low cost relates compromised quality’. Majority of the respondents expressed that future strategies should be directed towards educated high income group to build confidence for generics and this should be possible until and unless the local manufacturers in Pakistan make themselves compliant with WHO Good Manufacturing Practices (GMP). CONCLUSIONS: The respondents showed excellent understanding towards generic medicines. They exhibited negative concerns and attitudes towards generic medicine utilization.  Still there is room for improvement, provided the confidence is built in consumers regarding generic medicines quality and efficacy, which in turn will pave the way for their quality utilization.