Generic substitution

[emelianenko]

Just wanted to get some opinions from pharmacists on generic substituion. Why is it only being implemented now? what problems/challenges to pharmacists face? from researching into this the main argument I have seen GPs make is that generics are not bioequivalent citing anti-epileptic drugs. What do pharmacists have to say on this?

[johnep]

Unfortunately, there are pharmacists who substitute already, whilst claiming for original. DOH will want to police this as will suspect fraud. Used to happen in early days of PI.
johnep

[emelianenko]

What about doctors arguing with regards to bioequivalance, is this argument of theirs substantiated or unfound? and why is it only being implemented now with the aim of reducing NHS costs?

[Pharmanaut]

What about doctors arguing with regards to bioequivalance, is this argument of theirs substantiated or unfound? and why is it only being implemented now with the aim of reducing NHS costs?

The products with bioequivalance problems are known.
They are documented in the BNF and the DM+D.
Costs are rocketing and the drugs budget is a 'low hanging fruit' when it comes to finding something to reduce.

Are pharmacists to blame because they dispense too many prescriptions?

[johnep]

Unfortunately, I believe the DOH have already milked the generics cow twice and not much left to cut. With all these items made abroad and the decline of the pound, then probability is that generics will cost more not less.

When I was working for a galenical co, I found that to the average person pharmaceuticals = huge profits, and yet I was appointed to marketing to try and save the galenicals division from being axed on grounds of unprofitability.

johnep

[emelianenko]

Thanks for the replies guys. Very much appreciated.

[Tony Schofield]

Most PCT drug budgets are underspent as category M has not rebounded as was expected.

Generic substitution has long been a possibility but the pharmaceutical industry, which employs vast numbers of people and earns a significant revenue from exports has been protected. I think on balance that has been a good thing.

However, the steady rush of expensive and extensively used drugs coming off patent has slowed. Most treatments now involve drugs that are off patent. As the industry has failed to supply a steady stream of effective new treatments they are vulnerable.

Of course industry would argue that a) increasing regulatory burdens and b) the activities of NICE and pharmaceutical advisers have reduced demand for new treatments until more evidence is available to support their use. Without use there can be no evidence so an evidence based approach has stifled innovation.

As with so many things, the truth is probably somewhere in the middle.

[Jeff]

What is the plan for generic substitution?
Allowed to - incentivised to - required to?
Will contractors be paid for hydrocortisone on Efcortelan scripts?
DT generic prices on the Discovery range?
If we do it properly (and the multiples will make sure that we do) it seems likely to cost the treasury (and the taxpayer).

Jeff

[johnep]

efcortelan promptly discontinued as soon as our local PCT suggested that Drs prescribe as so much cheaper than hydrocortisone.
johnep

[Part Timer]

Can someone explain to me the deal with Discovery/Efcortelan being so much cheaper than DT generic prices? Is it a loss-leader-type situation, or what?

(I'm an employee relief pharmacist who's a bit out of the loop with pricing and stuff, or maybe I'm just being dim, so go easy on me please!)