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DH predicts 'significant increase' in demand for generic Viagra under plans to widen access

GPs face a ‘significant increase’ in the number of consultations for erectile dysfunction, if plans to widen access to sildenafil on the NHS go ahead, Government estimates reveal.

The DH says it expects demand for the generic version of Viagra on the NHS could double or even treble in primary care if restrictions on prescribing are lifted.

The Department of Health has launched a consultation on the plans that it concedes will place more of a burden on GPs in particular.

Since coming off patent last June, the cost of sildenafil to the NHS has plummeted by 93%, from around £21.00 to £1.50 for a four-tablet pack of sildenafil 50mg, leading to calls for prescribing restrictions to be lifted.

Currently sildenafil and other erectile dysfunction drugs can only be prescribed on the NHS to men if they have certain conditions – diabetes, multiple sclerosis and prostate cancer – or if they have significant distress as a result of erectile dysfunction, in which case they must first be referred to a specialist for assessment.

GP prescribing leads have already predicted GPs will be less rigid about restricting access to treatment for erectile dysfunction with the availability of generic sildenafil, while many practices have been actively encouraged to switch patients already receiving treatment with other drugs onto sildenafil, to take advantage of the price drop.

But one GP prescribing expert told Pulse that it might make more sense to make the drug available over the counter to ‘reduce the onus on GPs’ to manage demand.

The DH is proposing to remove sildenafil from the list of restricted erectile dysfunction drugs under Schedule 2 of the GMS contract 2004 prescribing regulations. Other listed PDE-5 inhibitors, namely tadafil, vardenafil and branded Viagra, will continue to be restricted.

The DH is seeking views on guidance on how sildenafil should be permitted more widely, but predicts that allowing unrestricted access to the drug would double prescriptions for the drug in primary care.

Allowing for the drop in price, this will mean the overall costs to the NHS will still fall substantially, from around £144 to £110.7 million a year.

The consultation says: ‘We recognise that the costs of the product only forms one part of the overall costs to the NHS and that widening NHS access will lead to greater costs elsewhere.

‘There would be an additional burden on primary care, in particular for GPs, as each new patient requires an average 1.9 consultations per year, at a cost of £68. There will also be additional costs relating to dispensing fees when the medicines are dispensed under an NHS prescription. However, any changes will bring in revenue for the NHS from any prescription charges.’

Dr Martin Duerden, prescribing lead for the RCGP and a GP in Conwy, said he welcomed the move overall, but cautioned it could place too much onus on GPs to arbitrate on whether the drug was being requested for recreational use.

He said: ‘A rapid move to over-the-counter provision of generic sildenafil might also make sense and reduce the onus on the GP to restrict access to an effective drug within the NHS. The responsibility would then lie with the patient to use it sensibly and safely. A lot of patients get the drug covertly via “online pharmacies” already and this might be a better, more transparent option.’

Professor Mike Kirby, visiting professor at the University of Hertfordshire and The Prostate Center, said he would be ‘delighted’ if the change was made.

He said: ‘I don’t think it would be abused and the health benefits are significant for the couples involved. People would still have pay for the script in many cases. It is a safe and effective drug that has been denied for many men.’

Professor Kirby added that GPs should feel more open to asking men about erectile dysfunction, as many are unlikely to raise the issue unprompted and because it offers the opportunity to ask patients about related problems

He said: ‘80% of men would like to be asked about sexual function but would not bring up the topic unless asked. It also provides an opportunity to address lifestyle issues.

‘Erectile dysfunction is a harbinger of underlying vascular disease in many men and an opportunity to address CVD risk factors and pre-diabetes together with hypogonadism.’

 

Readers' comments (5)

  • Just to save time, let's get these out of the way:

    NHS England is going soft on the viagra restrictions
    NHS England are going to have a hard time reducing demand
    Viagra has stiff competition from the other drugs
    Dept of Health accused of living in an Ivory Tower regarding viagra
    Dept of Health considering erecting restrictions around more prescribing

    etc

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  • Headline:

    Jeremy Hunt going soft on prescribing restrictions

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  • Vinci Ho

    Extraordinary circumstance -
    While restriction still applies , I wonder what is the street price of Sildenafil ? There are certainly a lot of fake Viagra in black market in other countries e.g. China ?

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  • Phil Yates

    This is a welcome change. For such an effective medication and such a common condition, it's good to see that the NHS is willing to loosen prescribing constraints.
    If drugs for other conditions were half as effective as sildenafil has been shown to be, the NHS would welcome their inclusion.
    I've always found it difficult to tell many impecunious men that we've got a very good drug that works, but that just a few tablets, to restore a perfectly natural bodily function, are going to cost them £50 or thereabouts.
    Pfiser have made a mint on Viagra, but it's good to see that now, off patent, the remit is changing to be more inclusive. That's got to be right.

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  • ‘There would be an additional burden on primary care, in particular for GPs, as each new patient requires an average 1.9 consultations per year, at a cost of £68.'
    Where do the DH get their consultation costs from?

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