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NHS England steps in after GPs' prescriptions of pregabalin were treated as 'significant event'

Exclusive NHS managers were forced to intervene after a pharmacy chain started alerting the local area team to a ‘significant event’ whenever GPs prescribed generic pregabalin.

HI Weldricks in Doncaster had asked its branches to take the action after receiving communications from NHS England and Pfizer, regarding a patent of the drug company’s branded version, Lyrica.

The communications came in response to a High Court ruling that the NHS should not promote generic pregabalin in instances of pain, although it can be used to treat epilepsy and generalised anxiety disorder, which are not covered by Pfizer’s patent.

As a result, NHS England issued guidance to GPs and pharmacists on 27 February saying that, ‘so far as reasonably possible’, GPs should stipulate Lyrica when prescribing pregabalin for pain and those dispensing the drug should give out the branded version.

Richard Wells, superintendent pharmacist at Weldricks, said that the letter from Pfizer had been ‘fairly blunt’ and that he had instructed branches to report to NHS England instances in which a GP continued to prescribe the drug in its generic form.

He told Pulse: ‘This is something we did initially so as not to fall foul of the threats from Pfizer.’

However, he said he was later contacted by the local pharmacy lead at NHS England, who said that such action was not necessary, after they had spotted reports that GPs were prescribing the generic version.

Mr Wells added: ‘This [was] not intended to put a wedge in relations between pharmacies and GP colleagues. We’d be more than happy to work with GP practices in any way we can.’

However, Dr Andrew Green, chair of the GPC’s prescribing subcommittee, said: ‘Whether or not we agree or disagree with Pfizer’s behaviour, to say that the issuing of a generic prescription – which, after all, remains a perfectly legal thing for a GP to do – is a significant event is an over-reaction and GPs will have better things to do than get involved in it.’

Earlier this month, the GPC advised GPs only to prescribe Lyrica for neuropathic pain, citing the risk of legal action for GPs and the likelihood that pharmacies under the same pressure would inundate GP surgeries with calls to clarify what the prescriptions were for.

A spokesperson for NHS England said: ‘The NHS is committed to ensuring the best outcome for every patient. The primary objective for this unique case has been to ensure that practitioners are aware of new guidance when dispensing certain pain medication. Information will be provided to CCGs outlining this advice.’

A spokesperson for Pfizer said: ‘Pfizer does not wish to take legal action against any individuals or organisations in relation to this matter. We are therefore continuing our collaborative efforts with stakeholders across the NHS to ensure the essential guidance and infrastructure is in place to support prescribers and pharmacists across the UK.

‘We recognise this is a relatively unusual situation and it is for this reason we have been engaging with stakeholders across the NHS for over six months to ensure essential guidance is available. We are confident that the central guidance and FAQ recently issued by NHS England will provide much-needed clarity and also help protect pharmacists from unwittingly infringing the patent.’

Readers' comments (29)

  • Absolutely marvellous. Another type of jeopardy to add to the long list.

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  • Solution to the problem:

    Don't prescribe pregabalin at all. There are similar medications that also don't work, but with less side effects.

    (tongue only slightly in cheek)

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  • what about pain and anxiety?

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  • practical soulution

    What if you prescribe
    pregabalin
    1 bd (for neuropathic pain)

    surely if you right like this chemist will give lyrica and be reimbursed- we then dont have to do a mass switch when goes off patent
    any prescribing whizz kids out there?

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  • Peter Swinyard

    So tempting to wax "lyrical" about this, but there may be a copyright problem.
    I though pharmacists normally queried directly to the GP if they were concerned about a script. This does prima facie appear to be a significant over-reaction.

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  • practical soulution

    What if you prescribe
    pregabalin
    1 bd (for neuropathic pain)

    surely if you right like this chemist will give lyrica and be reimbursed- we then dont have to do a mass switch when goes off patent
    any prescribing whizz kids out there?

    Unfortunately the reason they won't do this is because the drug tariff price will drop for the generic and they will only get paid that price if it's still generic, not the Lyrica price...

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  • Anonymous 10:40 - seems a really sensible solution but wouldn't work as NHSBSA would simply reimburse the generic.
    The pharmacy would be forced to dispense branded at a loss (as they would only be paid for the generic) or they'd get the patient to bring the script pack to the surgery so it was rewritten as Lyrica.

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  • Why isn`t there more media exposure to the public about this?

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  • GP's had better get used to this, particularly if the TTIP trade con/deal is signed.

    It started with movies and TV Series, individuals being hounded and in many cases bankrupted and imprisoned because of copyright theft, now we see 'Big Pharma' flexing it lawyers muscles, and threatening the NHS.

    I agree with others here Pregabalin, choose an alternative with less adverse effects!

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  • A spokesperson for NHS England said: ‘The NHS is committed to ensuring the best outcome for every patient.

    BIggest load of tosh. This is a patenting issue and Pfizer are just trying to grab as much dosh as they can. How did we allow this to impact on our professional lives I don't know. Significant event for them, nonsense for me

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