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Viagra prescribing restrictions scrapped



GPs can now prescribe generic Viagra to any man with erectile dysfunction, after the Department of Health finally scrapped unpopular prescribing restrictions.

The reversal, which a GP leader has said addresses “an historic injustice”, will now see the NHS fund all prescriptions for generic sildenafil, regardless of clinical circumstances.

Previously, the drug was restricted to men with conditions such as multiple sclerosis, diabetes and prostate cancer, due to fears of a cost blowout.

However the expiry of Viagra’s patent in June 2013 led to the drug’s cost to the NHS to plummet by 93%, from £21.27 to £1.45 for a four-tablet pack, prompting the Department of Health to lift the restrictions, which had stood since 1999.

The changes apply only to generic sildenafil and apomorphine hydrochloride – the DH decided against lifting restrictions on branded Viagra and other ED therapies such as tadalafil, alprostadil and avanafil.

Dr Andrew Green, chair of the GPC clinical and prescribing subcommittee, welcomed the move, saying it “partially corrects an historic injustice done to men, and their partners, who were denied an effective treatment for a distressing condition”.

“Erectile dysfunction remains the only condition to my knowledge where the entitlement to NHS care is dependent not on the condition itself but on its aetiology. It remains unjustifiable that men with impotence due to medication side-effects, for example, are denied treatment in contrast to those who have the same problem but due to surgery,” he said.

Surrey GP and clinical adviser to RCGP on prescribing, Dr Martin Duerden said the previous restrictions had ‘denied many patients with genuine need access to an effective intervention’.

He said: ‘Patients getting private prescriptions for these drugs should now be offered the opportunity of changing to generic sildenafil on NHS script, if they wish. However they may still prefer paying for the brand product if they find this works better for them.’

The change to the legislation follows a consultation earlier this year by the DH. It received 87 responses, 81% of which supported the proposal to widen access to generic sildenafil.

By boosting access through the NHS, the changes could also help stem the trade in counterfeit and unlicensed Viagra from unregulated online pharmacies, a DH consultation paper states. However some submissions felt the move could have the opposite effect, leading patients to on-sell their drugs via the black market.

NHS England will now consider whether to issue further guidance about appropriate prescribing.

The changes are likely to have a significant impact on GPs’ workload: an earlier impact assessment predicted demand for sildenafil could as much as treble once the restrictions were lifted.