Doctors told to save cash on prescription drugs

Jan 28 2008 by Madeleine Brindley, Western Mail

The House of Commons’ Committee of Public Accounts has recommended the NHS prescribes more generic drugs, rather than their more expensive branded counterparts. But are generic drugs as good as branded medicines, or are patients losing out when they are prescribed an older alternative? Health Wales brings together two leading experts to debate the issue

WHEN commonly prescribed branded medicines reach the end of their period of patent protection there is usually a significant drop in price.

This happens when competing manufacturers are able to produce copies of the original, so-called generic, medicines.

The generic manufacturers are able to produce these medicines more cheaply because they have not had to bear the cost of the research and development and clinical trials required to bring the medicine to the market in the first place.

This cost has to be recovered by the original pharmaceutical company through sales of this medicine before the patent expires and the generics arrive on the market. The research and trials are essential to ensure the drugs meet the standards of safety, efficacy and quality demanded by the medicines regulatory process in the UK, controlled by the Medicines and Healthcare products Regulatory Agency (MHRA).

In primary care in Wales, £579m was spent on medicines last year.

GPs are actively encouraged to prescribe products by their generic name and this is measured across all local health boards in Wales. The all-Wales average is 82% but there is scope for improvement – pharmacists are unable to switch to the generic product if the branded product is written by the GP. In Wales, the net ingredient cost of each prescription item is £9.80, which compares well with England where the figure is more than £11.

On average, in Wales, we each receive 19 prescription items per year which is higher than England where the figure is 15. In Wales, more than 57 million prescription items are written and dispensed per year.

The issue of quality of generic medicines is often raised as an argument against their use.

These medicines have to meet the stringent quality, safety and efficacy standards applied to branded medicines. The manufacturers are inspected and regulated to the exacting standards applied by the MHRA in the same way that they are applied to the major pharmaceutical companies.

When a new scientific breakthrough identifies a new therapeutic target to treat a particular condition several pharmaceutical companies undertake research in a race to develop drugs which have the same therapeutic effect.

The time in which each of these similar drugs reaches the marketplace will vary according to the speed at which the clinical trials are undertaken and the order in which licences are granted by the MHRA. These drugs will therefore reach the end of their patent protection period at different times.

Thus several branded medicines for the same condition will be available, and their cost is generally comparable. This explains why several medicines for the same condition are marketed.

The pharmaceutical companies promote their particular medicine to doctors to ensure they gain some market share.

Where the therapeutic effect of these similar drugs is essentially the same – such as statins to lower cholesterol – doctors are encouraged to prescribe the cheapest version.

This process is intended to ensure that the NHS gets good value for money and this enables these savings to be re-invested in the newer significant advances to treat other conditions.

There are significant potential savings to be made in the prescribing of generic medicines instead of the more expensive branded products.

This can be illustrated by the use of statins – Simvastatin and Atorvastatin .

Prescribing has been compared across Wales for the past two years since Simvastatin became available as a generic. The relative cost of these drugs for the commonly used 40mg dose is £3.80 for 28 Simvastatin versus £28.21 for 28 Atorvastatin.

If doctors prescribed the cheaper Simvastatin for the majority of their patients – say 70% of them – then a saving of more than £15m could be made each year across Wales.

But it would be unrealistic to expect all prescriptions to be changed to the cheaper generic because some patients may have a clinical reason, which means they would be unable to tolerate the other drug.

The message is getting through to prescribers, as the numbers of items of Simvastatin dispensed are growing and the expenditure on the expensive Atorvastatin is reducing, but this should be happening more quickly.

There are several other examples where prescribers continue to use the expensive branded products in favour of cheaper generics, which is a waste of scarce NHS resources.