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GPs to shoulder costs of reversing patients from branded to generic pregabalin

GPs will not receive any compensation for the costs of the switching patients back from branded Lyrica to generic pregabalin, Pulse can reveal.

NHS England told GPs they will need to switch their patients back to generic pregabalin, having told them in 2015 that they must specify Lyrica when prescribing for neuropathic pain as a result of an ongoing legal dispute.

GP leaders warn that moving patients back to generic pregabalin is outside contractual requirements, and would require extra resources.

But a spokesperson for NHS England told Pulse that 'GPs will not receive any compensation for the costs of the reversal.'

This is the latest blow for GPs in the row over the pregabalin prescribing (see box).

Dr Andrew Green, clinical and prescribing policy lead at the GPC, said: ‘Where patients are changed from one drug to another for the benefit of the health economy rather than the individual, the work is outside our normal contracts and practices need to be supported not only for the resources needed to change the prescriptions but also for dealing with any patient queries or problems that result.

'Of course we support cost-effective prescribing but the investment that is needed for that to happen must come from the organisation which will benefit, and not from GPs ourselves.’

Dr Andrew Mimnagh, NHS Sefton CCG lead on urgent care, told Pulse: 'The problem is that NHS England only ever see the small triviality of what they are asking us to do rather than the bigger picture. It's squeezing yet another grain of life out of drowning general practice.'

He added: 'I can see that the NHS would not be minded to offer us money as they are as cash strapped as everyone, but perhaps they could offer some dedicated pharmacy support.'

A Pfizer spokesperson said: 'We believe that the NHS England guidance has helped to bring some clarity to prescribers and pharmacists in this unusual and complex situation. We know through our experience with the Lyrica situation that the absence of any national policy for second medical use patents in the UK has been the cause of concern for many, including us.'

CCGs had asked NHS England to recompense them for the work undertaken by practices in prescribing Lyrica, and Pfizer offered to pay costs to GPs who were making the switch from generic pregabalin to Lyrica.

This comes as there are calls to reclassify pregabalin as controlled drug following evidence it is increasingly used recreationally and in prison populations, with greater evidence of addiction.

How the row over pregabalin prescribing unfolded

In 2014, Pfizer claimed that it held a patent over pregabalin when prescribed for neuropathic pain, as opposed to its use for epilepsy and anxiety, and took the matter to court.

A High Court judge said in early 2015 that, while the case was ongoing, NHS England had to issue guidance to GPs in a bid to prevent any potential infringement of a ‘second medical use’ patent Pfizer claimed it held for pregabalin.

It also wrote to pharmacists telling them to refuse any GP prescriptions for generic pregabalin if there was any indication it was for neuropathic pain.

The move required GPs to review and switch thousands of repeat prescriptions for pregabalin to ensure that only the branded version Lyrica was dispensed to patients being treated for neuropathic pain.

Pfizer continued to appeal rulings from the High Court and the Court of Appeal, which both found against them, but the second patent was due to run out in July this year anyhow. 

Following the expiration of the second patent last month, NHS England wrote to GPs asking that they return to prescribing pregabalin according to 'normal practice' for the treatment of 'any condition' after the lapsing of Pfizer's second patent for neuropathic pain.


Readers' comments (9)

  • Better rub 'switch pregabalin to Lyrica' off my 2015 'to do' list then.

    Just as well I didn't get round to it.

    The legal guidance was never robust or indicated it was the clinician's role to specify the brand anyway.

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  • Ignored keep as is no change.

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  • There must be a case at some time to refuse these dictats. What are the CCG doing on our behalf?

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  • Usually meds management teams from the CCG like to spend 000's to save a few pennies and are happy to use GP time as its a free resource to them.

    Whats worse is that pharma/ suppliers can easily bypass whatever meds management want to do because they're so slow and inflexible and do not understand pricing mechanisms.

    True savings are possible but need to be dome with GP support not by annoying them and wasting their time

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  • I'm thinking, why is this news? It's the tip of a very big iceberg when it comes to GPs wasting shedloads of time switching one medication to another on grounds of cost, availability or some other non-clinical reason. I don't see anyone tipping money on to my desk in compensation for all the time I've spent twiddling with patients' diltiazem regimes in the last few months, or dealing with the highly inconvenient shortage of topical betamethasone and clobetasone a couple of years ago.

    (I might just leave them all on Lyrica. It'll be an easy win if the prescribing committee picks it as an audit target somewhere in the future.)

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  • dreadful drug, dreadful company, dreadful decision.
    1 no new GP prescriptions for gabapentinoids. consultant wants them, they prescribe.
    2 on Lyrica , stay on Lyrica. Meds management can do the change and take the flack, if not , no change.
    3 resource us to call them in and agree a plan, probably 3 appointments of 20 mins each so 3x£56 per change, cheaper than Lyrica

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  • Vinci Ho

    Gave two fingers to Lyrica(hence , Pfizer) in 2015 . Hardly remember any patient specifically on Lyrica now. Whatever brand they are on , too busy to switch back to generics. Kiss my a***.
    After all Pregabalin and Gabapentin should be controlled drugs now.

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  • Good job for our community pharmacist

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  • If NHS tariff prices kept up with market prices, we would not be in this mess.

    The current situation is that if we prescribe generically, but there is a brand that comes in significantly below tariff, the pharmacist can buy in the brand and dispense, but bill for tariff and pocket the difference.

    This ensures there is absolutely no incentive from the community pharmacists to get this sorted.

    Meanwhile if we, the GPS, start prescribing Branded, we can chase cost savings which are constantly changing and frustrate are patients and pharmacists as they have to order in Alzain, Axalid, etc etc, or whatever slightly cheaper brand comes in next. Meanwhile the patient waits, and the pharmacist is annoyed because they have a shelf full of differently branded pregabalin which they can't use.

    Problem is, some of the savings are not to be sniffed at. Modified release quetiapine for instance can be hundreds of pounds cheaper if prescribed as a specific brand that undercuts the market Leader.

    My practice is to ensure I start patients on the cheapest option, whether that's a brand or generic. Once a patient is established on a particular option, it's a little more difficult decision to switch them as it will likely cause inconvenience, which we are trading off against the potential cost saving.

    I am reliant on the pricing for shown in EMIS Web. It's difficult to know how up to date these are, as the NHS BSA changes the reimbursement for drugs regularly. In my CCG area, we are in the strange situation of being asked to switch patients back to generic pregabalin, even though EMIS Web tells me that generic pregabalin costs significantly more than several of the brands I can choose from. We are told that the generic price will come down soon.

    This is exactly the sort of work that doctors and other smart people are ideally placed to do. The problem is there aren't really that many doctors to go around. Perhaps some other smart people can be brought in, people with experience of managing medicines? Pharmacists maybe? Then we will be in the strange position of having GP practice pharmacists competing with community pharmacists to minimise costs or maximize profits respectively.

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