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Don’t leave policy on drugs costs to me



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