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Generic drug switch ‘may cost more’

By Nigel Praities

Plans for pharmacists to automatically switch patients from a branded to a generic treatment may increase the cost of treatment rather than reduce it, researchers claim.

Their study found little clinical or economic evidence to support the policy of generic substitution for patients with hypertension. It reviewed evidence for switching blood pressure treatments such as ACE inhibitors and ARBs, and concluded the policy could actually raise the cost of treatment, with additional clinic visits, laboratory tests and the cost of poorly controlled hypertension.

The review was published online by the British Journal of Clinical Pharmacology with editorial assistance funded by Novartis, comes a week after Pulse revealed both the BMA and pharmacy leaders have submitted consultation responses opposing the plans.

Study leader Professor Atholl John, professor of clinical pharmacology at Barts and the London School of Medicine, concluded: ‘The general perception among physicians is that an approved generic is identical to the branded original. However, for marketing approval a generic only needs to demonstrate equivalent average pharmacokinetic properties, not safety or equivalent efficacy.

‘Switching is likely to incur costs through other aspects of healthcare provision, such as clinic visits and laboratory tests.'

Dr Terry McCormack, a GP in Whitby, North Yorkshire, and member of the Primary Care Cardiovascular Society, said he did not have a problem with generic substitution, except in certain cases.

‘Generic substitution is unwise with calcium channel blockers as they have been shown not to be pharmacologically equivalent. Occasionally we have a patient who cannot tolerate a generic compared with the brand, but they are quite rare,' he said.

Generic substitution may be unwise with some drugs, such as calcium channel blockers


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