OBJECTIVES: According to United Nations Development Program (UNDP) Report more than 65% of the population earns less than two dollars per day and thus, affordability of medicines is a critical issue in this highly vulnerable group. This research study aimed to investigate the understanding of generic medicines among low-income groups in peri-urban communities of Karachi, Pakistan.   METHODS: Qualitative methodology was adopted to collect in-depth information on this unexplored issue. Ethical approval for the study was sought from Ministry of Health, Government of Pakistan. Research participants were recruited by snowball sampling. After obtaining informed consent thirteen semi-structured interviews were conducted from January 2009 to March 2009 in two peri-urban communities of Karachi, Pakistan. The interviews, which were conducted till the point of saturation, were audio-taped, transcribed verbatim and translated into English for analysis. RESULTS: Interview transcripts were subjected to content analysis for the identification of themes. Specific emergent themes included a) deficient knowledge of generic medicines; b) drug seller as the solo medicine provider; c) contact to medical doctor in children illnesses; and d) belief in alternative therapies.  None of the respondents identified the concept of generic medicines. On explaining to them about generic medicines all of them expressed their ignorance about the presence of cost-effective alternatives. All of them preferred to contact medical store/druggist/chemist shop/pharmacy for their minor and major ailments, communicable and non-communicable diseases.  Interestingly, most of the respondents agreed to visit public hospitals or contact medical doctors only in case of their child’s illness. Most of the respondents showed their trust in herbal therapies rather than allopathic medicines CONCLUSIONS: The current study identified absence of understanding of generic medicines. Mass media awareness campaigns should be used for educational initiatives to inform the consumer about cost-effective alternatives