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GPs face bans on high-cost drugs

By Lilian Anekwe

Exclusive: GPs are being banned from prescribing high-cost drugs approved by NICE as NHS managers seek drastic savings on prescribing budgets.

More than half of primary care organisations have brought in new blacklists within the past year, a Pulse investigation reveals.

PCOs are redrawing formularies in changes they estimate will slice £250m from this year's drug budget. Responses from 134 PCOs under the Freedom of Information Act show that more than half have blacklists of drugs – in some trusts of more than 100 – that GPs are banned from prescribing.

Some 73 PCOs said they had added drugs to blacklists or placed additional restrictions on prescribing in primary care in the past year, as they strive to make average estimated savings in 2011/12 of £1.9m each.

It comes as practices were handed the mammoth task of meeting ambitious QOF targets set in new quality and productivity indicators, and given just three months to agree three areas of improvement with their PCO (see below). Pulse's investigation suggests practices will struggle to reach agreement with trusts or health boards as many have restrictions that fly in the face of national guidance.

Restrictions often cover NICE-approved drugs, including gliptins for diabetes, denosumab for osteoporosis and both atorvastatin and rosuvastatin – green-lighted in some circumstances by the National Prescribing Centre.

Other drugs have been blacklisted on the basis of ‘low clinical priority', including drugs for Parkinson's disease, newer contraceptive pills, erectile dysfunction drugs, some NSAIDs, the weight-loss drug orlistat and homeopathic treatments.

NHS Cambridgeshire has added 32 drugs in the last year to its ‘redlist', which now covers more than 100 drugs ‘that will not normally be funded for prescribing in primary care'.

Other trusts are encouraging GPs to explore ways of avoiding prescriptions altogether, by recommending weight loss and nutrition advice or relying on non-medical prescribing.

The situation is worse in Wales, where prescriptions have been free since 2007, and the Aneurin Bevan local health board in Torfaen is targeting nearly £5m in savings this year.

Hywel Dda local health board has instructed GPs to push patients to buy their medicines over the counter. ‘Practices are requested to limit their prescribing to small quantities for all acute episodes and to encourage patients to manage minor ailments,' the board said.

‘The current economic climate may affect individuals' purchasing ability but at the same time, considerable pressure is being felt in the NHS.'

NHS Milton Keynes said it intends to ‘levy a fine against each consultant-to-GP letter requesting the prescription of a non-formulary medicine'.

Dr Duncan Outram, a GP in Alconbury, Cambridgeshire, said: ‘We have a duty to prescribe a cheaper alternative if all things are equal. But putting drugs on blacklists purely on cost grounds is indefensible.'

Drugs on PCOs' blacklists

• Amlodipine and olmesartan
• Atorvastatin
• Diclofenac spray gels
• Escitalopram
• Esomeprazole
• Exenatide
• Glucosamine
• Grazax
• Indacaterol
• Intanza
• Liraglutide
• Oilatum
• Oxycodone and naloxone
• Prednisolone enteric-coated tablets
• Rosuvastatin
• Sitagliptin
• Tadalafil
• Vildagliptin

Source: Pulse FOI of 134 PCOs

Rosuvastatin is one of the drugs black-listed by PCTs