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GPs go forth

Don’t leave policy on drugs costs to me

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It will be no surprise to GPs up and down the country that our colleagues in Lothian will be subject to an investigation for spending too much money on prescribing. Name and shame bar charts of prescribing patterns per practice have become commonplace these days, and ‘must try harder’ notes from prescribing advisers are routine.

I’m not against the idea that our prescribing patterns should be scrutinised, or that there should be local guidelines on cost-effective prescribing. I do feel that we should all be doing our part to keep costs down – not just those of us who actually sign prescriptions.

I say this because the fuss over the price of phenytoin has shown me that when it comes to policing the cost of drugs to the NHS, we are being seriously let down. In September 2012, Pfizer sold the distribution rights of Epanutin to another pharmaceutical company, Flynn Pharma, and in the process the price of the drug rose by 25-27 times. Since we have to prescribe antiepileptics by brand (and since Epanutin is the only branded phenytoin available in the UK anyway), GPs were powerless to avoid the price hike. As a result, in the past two years the NHS has forked out more than £85m extra to pay for this drug.

Surely someone in charge of the NHS purse strings should have noticed and started asking questions? Well if they did, they kept very quiet about it.

I warned about the issue as far back as October 2012, because I believed it to be an abuse of a monopoly position. Stephen Adams took up the story in The Telegraph, but no one else seemed interested. When Mr Adams contacted the Department of Health he received a lacklustre reply, repeating the Pfizer line that it was important to keep the drug available for patients.

I submitted evidence to the Office of Fair Trading (the predecessor of the Competition and Markets Authority) in July 2013. They looked into it but (these things take a long time, don’t they) only recently issued a statement of objections to both Pfizer and Flynn, saying their ‘provisional view’ was that both companies ‘abused a dominant position’ and breached competition law.

If this judgment is confirmed, the companies could face a hefty fine and be forced to return the price to 2012 levels.

I don’t know what alerted the OFT. I dare to hope that somewhere in the bowels of our NHS there is someone whose job is to police unfair price increases and protect our spending. Perhaps they did their job, researched the issue thoroughly and submitted a detailed report to the OFT. Perhaps – but I’m left with the unnerving impression that it may have been down to a GP writing an amateur blog in his spare time.

If this is so, then someone, somewhere, should have questions to answer.

Dr Martin Brunet is a GP in Guildford. You can tweet him @DocMartin68

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Readers' comments (7)

  • Dear Martin,
    There are indeed questions to be anwered.

    Thank you for your activism on this matter where vested interests yet again have triumphed in the NHS and costing us dearly.

    I have found that it is not always easy to speak out about these matters. Your inegrity marks you out Martin. In my opinion (actually in my experience) we have too many senior leads who do not stand up for what matters.

    I do hope that we get some definitive responses on this matter soon and that these are shared in the public domain by the powers that be.



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  • Unfortunately the drug company may feel they will reduce supply to the UK market and then you may be in trouble.

    Obviously immoral, but you'd be surprised how tight things are in industry despite headline profitability

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  • NHS CCG Pharmacists raised this issue with the OFT and submitted evidence. Yes it has taken far longer than expected but lets hope some the result is positive.

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  • well, i think the folks that have shares in these companies are also the folks who are responsible to investigate, so they have vested interests.

    thats why the NHS is being held to ransom over drugs like epanutin, and things like benzoyl peroxide etc.

    If NHS budgets are being squeezed, but drug companies can hold the NHS to ransom, surely the sweet deals that these companies have in terms of tax relief, and their contracts with the NHS should be discussed and brought to the public attention.

    Unlikely to happen - these are strange times we live in.

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  • As an epilepsy specialist, there were several ways to avoid this issue. Many if us alerted "those who should take action" about the problem some 3 years ago, however, as Martin says, nothing was done. Therefore, we have some choices to consider.

    Firstly, phenytoin is not a drug of choice due to the well known side effects and interactions, and the availabliltiy of many less harmful alternatives - in our Trust we used this as a prompt to review meds and change to more modern antiepileptics, to the benefit of patients.
    Secondly, 20-30% of patients recorded to have epilepsy, particularly the elderly with historic diagnoses, actually do not have it and phenytoin can be gently withdrawn after specialist review.
    Finally, if phenytoin is the drug of choice, which will apply to very small numbers of patients, then the liquid preparation could be used instead.
    The drop in prescriptions following these actions could influence the decisions around price increases for the future.
    The questions regarding the business practises and cost still remain to be answered nonetheless.

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  • The entire system reeks of corruption.Big Pharma have the politicians in their pockets.I know this from a friend of mine in Whitehall

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  • The entire system reeks of corruption.Big Pharma have the politicians in their pockets.I know this from a friend of mine in Whitehall

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