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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

MPs want drugs bill controlled

According to an article on the BBC website MPs are recommending that more is done to control and contain the annual NHS drugs spend.

According to the article, spend has doubled in a decade to £8.2 billion each year. Recommendations included greater use of generic drugs, putting prices onto packets so patients are aware of the cost of their medicines and restricting the influence of the pharmaceutical industry by forcing GPs to declare significant gifts and hospitality. MPs also cite the variation in the use of cheaper statins; in some trusts use is just 28% while in others it is 86%.

The Pharmaceutical Industry refute many of these recommendations stating that branded drugs are under-used in Britain and that generic prescribing rates are the highest in relation to comparable countries. Despite this the article reports that 20% of GPs admitted to being more influenced by pharmaceutical firms than NHS advisers.

There does not appear to be any mention of the impact of earlier detection, diagnosis and treatment of a wide range of medical conditions and the obvious increase in drugs spend that would be associated with this change.

Action: Clinicians may wish to reflect on their current prescribing habits and make greater use generic medicines where appropriate before changes are enforced. NHS advisers may wish to the results of the reported survey and assess how they can affect greater influence and prescribing change.

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One Comment to “MPs want drugs bill controlled”

  1. An Inexpensive Patient Benefit

    More now than in the past, generic medications have been encouraged by prescribers at a much higher rate due to the problem of the high cost of branded meds that many find unfair and unreasonable. Branded meds are still prescribed often, though, mainly due to samples of such meds provided at a doctor’s office from the sales reps who promote these meds. Generics typically are not sampled due to lack of funds compared with branded pharmaceutical companies. Yet generics cost a small fraction, such as a third of the cost, of the same branded meds that are supposed to have the same molecular bioequivalence. In other words, they are supposed to work the same as the branded equivalents in relation to safety and efficacy. Yet not all branded meds have a generic formulation due to patent exclusivity and therefore cannot be produced until the expiration of this patent of the branded med.

    Not long ago, generic meds were not prescribed that often, or produced to a great degree because of the cost of bringing such a med to the market, which at the time required the same protocols as branded meds. Fast forward to 1984, when the Hatch-Waxman Act was introduced, and this Act only required generic meds to demonstrate bioequivalence to the branded med that they desire to reverse engineer, and nothing else included in the approval process. The reduced cost of generic production allowed for more of these meds to saturate the market, and doctors started prescribing more generic meds as a result. Branded pharmaceutical companies were not pleased in large part with this new act, so they devised schemes to extent the patents of their branded meds, through such tactics as reformulation, which is called Evergreening, of their meds and frivolous patent infringement lawsuits, which delay generic availability for a longer period. Yet pharmacies support generic use, as they make more money off of generics compared with branded meds. So delays will not prevent the utilization of generics, overall, and thier use has increased even more over the past few years. Generics seem to remain such a concerning threat of branded pharmaceutical companies in spite of their efforts of avoiding their access, that branded companies have progressively started producing their own generic meds along with their branded ones due to the increased use of generics. Novartis Pharmaceuticals is an example of this strategy of possessing and promoting both branded and generic medications.

    Also, other reasons for increased generic prescribing is due to the awareness and clinical experience of the previous branded med that has been replicated by the generic med. Newer drugs at times are not a desirable choice of treatment for patients because of lack of confidence of the prescriber- safety being the main concern with some prescribers. So the familiarity of a generic equivalent of a known med creates a more reassuring choice for the prescriber. Available generics are listed in what is called an orange book. It should be available to all health care providers for their access. Managed Care Companies share the same paradigm regarding generic meds that some are actually paying prescribers to switch and prescribe generic meds for thier patients, possibly without the knowledge of the patient of this occuring. And this may be happening due to the branded pharmaceutical companies inducing prescribers all the time, so perhaps this is a response by the managed care companies.

    Most encouraging for even greater use of generic meds is that at least one company has created vending devices for doctor’s offices for dispensing both generic and over the counter meds. This may discourage the use of branded equivalent meds at a greater amount with generic samples available as well as the branded meds that are present in a doctor's office. In addition, and in some cases, doctors can order generic samples from the manufacturers. Knowledge is a good thing when it comes to prescribing choices.

    Yet some doctors insist that you get what you pay for, so they are convinced that branded meds are always more efficacious and tolerable than generic meds. This misconception is a fallacy, since both forms are identical from a bioequivalence and bioavailability paradigm, as required for approval. I’m sure it’s possible others have encouraged such doctors to take such a stance void of fact and reason. Yet there may be some truth to this, as some claim that generics are in fact less efficacious than the branded meds. Only testing the branded versus the generic meds would validate the claims.
    Considering the health care crisis in our country and the over-priced treatment methods in our system, as with branded pharmaceuticals, generic medications should be considered when clinically appropriate for the benefit of those seeking restoration of their health. It would beneficial for patients to become aware of this pharmaceutical system and request generics when being prescribed a med by their health care provider. In other words, they should question authority figures such as doctors are perceived to be, as patients definitely have a right to acquire knowledge and use this for their benefit with situations as their choices for treatment options, as this will be for their financial benefits while improving their well-being with generic medications- an ideal way to reduce health care costs and improve compliance with their meds because generics are an affordable asset to public health.

    "Most people would die sooner than think. In fact, they do so." --- Bertrand Russell

    Dan Abshear

    Comment by Dan — October 4, 2008 #

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