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


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.

Posted date

25 Aug 2017

Posted time