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NHS England presented with bill for pregabalin switch by CCG

Exclusive Commissioning leads have billed NHS chiefs thousands of pounds for carrying out reviews of all their GP practices’ prescriptions of pregabalin, Pulse has learned.

The bill for NHS High Weald Lewes Havens CCG came to more than £4,500 after prescribing managers decided to take the work off GPs’ hands.

It is the first CCG to make such a move, after NHS England had told GPs they would have to prescribe the branded version of pregabalin – Lyrica – when used for neuropathic pain.

NHS England had itself been instructed to send the guidance by the High Court, in an attempt to prevent infringement of Pfizer’s ‘second medical use patent’ on pregabalin relating to the treatment of neuropathic pain.

GPs had pointed out that the ruling not only curtailed their prescribing freedoms, but also involved extra work in reviewing all patients.

The guidance made clear that GPs needed to undertake the switch-over as soon as possible and that ‘there are no additional funds to cover costs of implementing this action’.

As a result of GPs’ concerns, NHS High Weald Lewes Havens CCG confirmed its medicines management team had reviewed all patients on pregabalin in order to switch those given the drug for pain onto the branded form Lyrica – and submitted an invoice for nearly £4,600 for the additional work.

A spokesperson for the CCG told Pulse: ‘The invoice High Weald Lewes Havens CCG has issued to NHS England is for the value of £4,578.75.’

The spokesperson continued: ‘As a GP-led membership organisation, we know the daily pressures facing general practice and we took the decision to review patients on pregabalin ourselves so we could leave local GPs to concentrate on their primary task of treating and caring for local patients.

‘High Weald Lewes Havens CCG is a relatively small CCG and as we have needed to resource this additional workload we have submitted an invoice to NHS England in order to cover these costs.’

Pulse understands the CCG is now discussing payment with NHS England.

The GPC has advised GPs to comply with the guidelines – which were also issued to GPs in the devolved nations – because the case is a ‘one-off’ and practices will otherwise inevitably face disruption as a result of repeat calls from pharmacists seeking clarification on prescription indications.

Dr Andrew Green, chair of GPC’s clinical and prescribing subcommittee, said: ‘It is relatively rare for the most common use of a drug to be for a different indication to the one for which it was developed, and for that indication to be subject to a separate patent. The BMA was made aware of attempts by Pfizer  to enforce use of their brand when pregabalin is prescribed for long-term pain, even though the brand is much more expensive and no more effective than the generic version.

‘Accordingly, we issued pragmatic guidance designed to protect doctors from personal legal challenge as well as from being distracted from patient care by pharmacists anxious about the intended use of a generic prescription.’

However, some GPs have warned the impact on practices has not been properly recognised.

Dr Steven Haigh, a GP in West Calder and member of Lothian LMC, in Scotland, said the work was yet another imposition on GPs who were already stretched too far.

Dr Haigh said: ‘General practice is at breaking point yet we are being asked to change quite a lot of prescriptions – we had to change about 40 in this practice – for reasons that had nothing to do with any clinical evidence.’

He added: ‘Everybody always says “it’s not much work”– an extra letter here, just spending a few extra minutes there. But you have to remember that general practice is covering the whole spectrum of medicine and much social care as well. We are endlessly being asked to do extra tasks that supposedly won’t take long but we have reached the point where we don’t have the capacity to do that.’

An NHS England spokesperson said: ‘NHS England has issued guidance, as ordered by the court, to provide assistance and support to clinical commissioning groups to protect prescribers and dispensers from inadvertently infringing the patent that Warner-Lambert has been awarded.

‘Overall we hope that the guidance has reduced uncertainty and saved additional time dealing with follow up questions.’


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