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Pharmacists told to refuse GPs' generic pregabalin prescriptions

Exclusive Pharmacists have been told to return GPs’ prescriptions for generic pregabalin instead of simply supplying the branded versions themselves in guidance endorsed by NHS England.

The advice – issued by pharmacist negotiators – tells pharmacists not to simply issue the branded form, Lyrica, when they are aware it has been prescribed for neuropathic pain, but instead ask the GP to re-issue a new prescription in an attempt to avoid disputes over patents.

The guidance comes in response to a High Court judgment, which saw NHS England and related bodies in Scotland and Wales issue guidelines to both NHS prescribers and dispensing chemists advising them only Lyrica should be prescribed and dispensed for the treatment of neuropathic pain.

GP critics say the new guidelines for pharmacists transfers additional uncontracted and unfunded work onto GPs.

It comes as a Pulse investigation has revealed there will potentially be more court cases that will determine what GPs are allowed to prescribe.

The GPC has advised GPs to follow the NHS England advice and review all their patients on repeat prescriptions of pregabalin to get them updated as soon as they can.

However, a ‘Frequently asked questions’ document produced by NHS England to accompany the guidelines goes further and directs pharmacists to withhold pregabalin that they are aware is prescribed for neuropathic pain.

They are instructed to use a template letter - held on the Pharmaceutical Services Negotiating Committee (PSNC) website - to tell practices they should reissue the prescription or face potential legal action from Pfizer, which holds the patent.

The template letter states: ‘I have received a prescription for generic pregabalin issued for [enter patient’s name] [enter patient’s DOB or NHS number] and have been made aware that it has been issued for the treatment of neuropathic pain.’

It adds: ‘So as to enable us to provide treatment for this patient, could you please reissue the prescription ordering the branded product Lyrica.

‘I am sorry that the patient could be inconvenienced and that the patent causes additional work for your practice, but Pfizer has made it very clear that breaches of the patent could lead to legal action being taken.’  

A spokesperson for the PSNC said: ‘The prescription must be amended because if generically written, the NHS expects the generic to be dispensed, not the brand.

‘Prescriptions nowadays are electronically produced, and producing the prescription also makes a record in the patient’s notes. If the GP were to hand amend the original prescription then they would separately have to make a record in the patient notes, which would mean extra work or it might not get done. So we have asked for a reissue.’

However, Dr Andrew Mimnagh, a GP in Waterloo, Merseyside, said the letter showed NHS England was forcing GPs to do uncontracted work to ensure the NHS does not breach Pfizer’s patent without incurring any costs related to the changeover.

Dr Mimnagh said: ‘There is no doubt in my opinion the work regarding pregabalin review and conversion was additional and uncontracted as it was not for the purposes of patient care or safety.’

He added: ‘Pharmacists were able to issue Lyrica against a generic prescription of pregabalin and could have asked the patient why they took the medication… The NHS England instruction to practices converts the physical medication cost on pharmacists to an abstract “supply of services” cost on GPs.’

Sue Sharpe, PSNC chief executive, said: ‘The situation with pregabalin is unique and NHS England has issued guidance to both GPs and pharmacists to explain how they must comply with the law. Where GPs do not follow the guidance, pharmacies unfortunately have no option but to ask them to reissue prescriptions – this has a further impact on workloads for both professions with no additional income for either.’

Pulse recently revealed commissioners in some areas have already disputed whether the work involved in following the guidance was covered by the GP contract, with one CCG billing NHS England for thousands of pounds to get all practices’ prescriptions changed over.

Readers' comments (20)

  • re the last 2 comments:

    That is exactly the attitude that leads to GPs being so overburdoned. Each "only a little job" adds up and before you know it, there is a mountain each day. It

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  • Vinci Ho

    Yes. One can swallow the workload easily but this is about establishment(s) bullying( a culture launched by this government )the weaker parties. You can criticise me politicising but sometimes this is the only way to protest......

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  • Sorry Vinci old chap, the bullying started immediately after the 2004 contract gave away our autonomy. It has been perpetuated by this coalition, but the earlier governments were just as bad.

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  • As a Amputee Peer Group representative, Many of whom are prescribed for neuropathic pain.

    Could one of you Dr or Pharmacists please tell us how this is going to affect the patient??? Are some or many of our peers going to be short of medication for Phantom Pain whilst this process is being argued over by the Surgery and the Pharmacist???

    Gordon McFadden
    United amputees Community Charity

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  • Nobody has suggested that, Mr McFadden. That would be unethical.

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  • Dear Mr McFadden
    As there will be less money in the NHS from 2014 - 2017 due to the cynical regulatory capture of patent laws by Pfizer there will be cuts to services. The services that will be cut first won't be cancer, children's services or big hospitals, but will be community services such as wheelchairs, prosthetics and specialist community wound nurses.
    Please understand we are very much on your side. It is Pfizer and the government who are to blame for this.

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  • I think the author is making a leap too far in describing this as "undermining freedom to prescribe". Granted it's the usual high-handed way these things seem to be done, but in essence:

    You have a patient with a condition for which there are two identical products, Brand A has a licence, Brand B doesn't. I would have thought common sense and best practice would dictate the licensed product is used. Given the principle of informed consent what are you telling the Patient? "I'm giving you the unlicensed one to make a point/save money?" It can't be for clinical efficacy because they are both the same drug.

    Of course if there are justifiable reasons why you might prescribe Brand B - allergic reaction to excipients in Brand A - then there's no problem - obtain informed consent, document the reason for the records and you've done everything that could be considered "reasonable".

    There's no problem with prescribing off-licence if there isn't a licenced alternative - nobody is saying it can't be done - but again best practice and prudence would suggest that is properly documented along with informed consent from the patient(?)

    Yes - it might bankrupt the drugs budget - but as it is Government Policy I would suggest letting the Government worry about it when they get the bills at which point they might rethink the policy.......

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  • The assertion writing it generically means the nhs expect it to be dispensed generically is plain wrong. If prescribed generically the reimbursement will be for the category M price which is currently lyrica price. So the pharmacy is not out of pocket and, providing the pharmacy dispense lyrica, then Pfizer ()spits involuntarily as he types) will get their drug used.

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  • I will simply be avoiding, where possible all Pfizer products. Use very little pregabalin anyway and the amount will fall.

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