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Drug switching legal battle threatens PBC

By Nigel Praities

GP prescribing incentive schemes and even practice-based commissioning could be threatened by a legal challenge on payments for drug switching, it was claimed this week.

The Association of the British Pharmaceutical Industry expects a date to be set for its judicial review of drug switching schemes by the end of the year, and told Pulse the case could have ‘wider implications'.

Lawyers from the ABPI were granted a judicial review of drug switching schemes in July, arguing that patients were being put at risk and GPs being paid illegally to prescribe specific named drugs.

But Sue Ashwell, chief pharmacist at Cambridgeshire PCT, told a special debate on drug switching, chaired by Pulse, that the case threatened a range of incentive schemes and discounts for bulk-buying drugs.

Speaking after the event, she warned: ‘Potentially, we as PCTs would not be able to reward or compensate practices for prescribing changes.' She said incentives for schemes such as care closer to home and PBC often rested on PCTs financially encouraging GPs to prescribe differently. ‘If you took that flexibility out it would be really hard to make it work.'

David Fisher, commercial director for the ABPI, said: ‘The point is, is it legal or not to pay a doctor for prescribing a named medicine? If I'm from a pharma company and I pay a doctor to prescribe a drug, I get thrown in jail. If my PCT colleague does the same, is that legal or not?'

He said there could be ‘wider implications' beyond drug switching, if the legal challenge was successful. ‘Our issue is to get clear on what the law says.'

Dr Nick Clements, senior medicolegal adviser at the Medical Protection Society, said the case had ‘a lot of implications' for PCTs, although he would be surprised if the courts extended this beyond drug switching.

He said GPs should not be penalised for incentivised prescribing as long as they followed Government guidance.

The Department of Health has issued interim guidance urging GPs to assess patients before switching treatments, and advising that incentive pay should be invested in patient services.

ABPI's case against drug switching

• Payments to prescribe named drugs are, it claims, prohibited in the Medicines Advertising Regulations 1994
• Case brought against the Government will review legalising of prescribing incentives and will be heard in 2008
• If unsuccessful, the ABPI could turn to the European courts, which could also affect practice in other EU member states

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