anjan bose

20/11/2008

this would mean that if I prescribe amoxil 100 ml[brand at 0.59 pence]the pharmacist could change to amoxicillin 100 ml[generic cost £1.42] or ventolin inh at £1.55 to salbutamol inh at £2.88--how on earth is this helpful ???

Sean Macbride-Stewart

20/11/2008

Because the same chemist can dispense generic alendronate 70mg \(pack of 4) for £1.82 when Fosamax Once Weekly is prescribed, current price is £22.80. The same applies to Losec, Prozac, Diannette, etc, etc.

Martin Gray

20/11/2008

I would hope the Government watchdogs would be policing the scheme for this very reason; it would only harm the pharmacists if they were to dispense more expensive equivalents. My only real concern would be were the generics were sourced from and what checks would be made to ensure the drug WAS at the correct dose and not 'watered down' as has been the case in the past. There is a lot of money to be made from selling generics and not all manufacturers/suppliers may be as scrupulous as we would want.

Patrick Drennan

20/11/2008

Will that mean that even if I have specifically written branded instead of generic script, as would be my normal behaviour, the chemist would overide that without consultation with me , or indeed, the patient? There are a few instances where the branded is not interchangeable with the generic \( e.g. fentanyl patches), or a generic has caused a reaction in the past with a particular patient \(e.g. some creams with sensitizers/preservatives in them). How about a competition for a suitable acronym to write on the script when you do not agree to an alteration? Here are some suggestions: OYC \(over your corpse); SMIMS \(see me in my study); BOC \(bugger off chemist); BOM \(bugger off mate); BOP \(bugger off pharmacist); HOP \(hands off pharmacist).

Amy Marshall

20/11/2008

As a doctor I almost always prescribe by generic name \(as I was taught to). However there are certain situations where I specifically want a patient to receive a branded medication - is our right to do that being taken away??

What about medications with different bio-availabilities such as anti-convulsants?

As a patient I get frustrated by the constant changing from one generic to another. Ever tried fitting a round ended inhaler into a Volumatic?

Some of the "repackaged" tablets are the worst - rather than properly repackaging they often cover over the foreign writting on the foil strips by putting large English language stickers over the top. You then have to push the tablet out through both foil and sticker, usually the pre-cut holes in the stickers don't align with the tray properly so you end up with tablets stuck to stickers or flying across the room as you try to pop them out of the packet.

Tim Webb

20/11/2008

"In response to Anjan and Amy"

I can see why you have brought these views to light and yes we need to put the patient's health first.

I am a pharmacist and will put this forward. If I receive a generic prescription for a non-bioequivalent drug I always check with the patient which brand they have received in the past and supply accordingly. Going forward I see no reason to change this practice. On the other side there are obvious savings to be made for the NHS if we can swap certain brands if we know them to be equivalent.

I am only one voice and cannot speak for the whole pharmacy network. However doesn't this practice currently happen in dispensing doctor settings \(i.e. one brand is written but, due to supply problems, another is supplied to allow continuity of treatment)?

I have only read the above story and haven't had chance to check out the full information. Does anyone have a link to the full story/document? Does it have conditions implied before a switch can be made?

Chris Doyle

21/11/2008

Tim, The full details of this scheme are not yet available. it is due to be introduced from January 2010 and there is a consultation period underway now. Hopefully the comments above will be addressed by that. Also: the comment above about fentanyl patches not being interchangeable - surely that's been put about by the makers of the original to defend their product - how can one 25 micrograms per hour be different from another 25 micrograms per hour?

Pasapula Subrahmanyam

21/11/2008

I do not know where we stand from medico legal point of view when a pharmacist substitutes to generic version and things go wrong specially with epileptics who is accountable? It is an interesting developmement when most of us already using generics. Offcourse it is a drive to bring down prescribing cost. Clearly needed some ground rules.

Patrick Drennan

21/11/2008

In answer to Chris - suggest you talk to your Palliative Care Team about the interchangeability. If it was a wheeze on the party of the original it backfired because local drug formulary wnet for the cheaper option and recommended no swaps!

Jon Hayhurst

24/11/2008

A system operates in Australia where a box is included on the prescription so that the prescriber can indicate that brand substitutions should not take place, in which case the pharmacist would dispense as such, and the PPA reimburse at the branded price. I don't think Dr. Drennan's 'OYC' should be necessary.

Surely the best way is for the PPA to reimburse prescriptions at the lowest price \(generic or branded) to account for the few medicines which are cheaper prescribed by brand, such as Ventolin when this arrangement starts.

I gather generic fentanyl patches are prone to falling off in the shower and often have to be held down with sticky tape. Patients used to say this with the reservoir patches, and no doubt Janssen reps will tell you it always happens with anything other than their brand.

RAJESH RAJPUT

30/11/2008

In reply to Anjan Bose ....In the scenario that you have mentioned, Looking at unit cost...this would not be helpful for the NHS budget. However if a pharmacy did not have the branded Amoxil or Ventolin to dispense for the patient who required it urgently...... this switch from brand to generic is helpful!!!

Mohammed Ahmed

02/12/2008

Should COMMON SENSE prevail here?

I work in both places in GP practice as a practitioner and as a pharmacist in community pharamcy. I utilize the computer systems in both places. If a patient needs a branded product (not able to tolerate) then write on the system (next to drug which prints on Rx) TO STAY ON BRAND. similarly I do that for all drugs I prescribed if I prescribe atorvastatin because of ADR to simvastatin then I add that information next to the drug, ACEII in place of ACEI then a reason is added.

Similarly if I am working in Pharmacy and if dispensing diltiazem  carbamazepine, valproate, Fentanyl etc etc then I ask patient which brand they are on and issue that.

I think we live in a society of MONEY MONEY MONEY. Majority of cases in public domain reported lead to someone trying to abuse system for their own BENEFITS. LETS all of us do our bit for NHS. Don't tell me that we all are? We all get paid for it. DONT MOAN CHEER UP BE HAPPY. Lets work together.