Pt choice of brand of medication

[johnep]

Pt came in to complain about her Salamol inhaler. She said awkward to use and would not stand on end for storage in cupd. She wanted to make sure she had an autolite in future. Looked at the inhalers with her and told her most people prefer the salamol. However, I do agree about inhaler not standing upright. have same problem with similar shape of Phillips Razor.

We also have pts who like a particular brand of atenolol (no colour) and say that alpharma soluble paracetamol tastes awful. this is where the ability to append notes in a PMR is so useful. However, at moment only Pharmacy mngr and Mediphase have this facility.
johnep

[BBL]

Re: Pt choice of brand of medication

Pt came in to complain about her Salamol inhaler. She said awkward to use and would not stand on end for storage in cupd. She wanted to make sure she had an autolite in future. Looked at the inhalers with her and told her most people prefer the salamol. However, I do agree about inhaler not standing upright. have same problem with similar shape of Phillips Razor.

We also have pts who like a particular brand of atenolol (no colour) and say that alpharma soluble paracetamol tastes awful. this is where the ability to append notes in a PMR is so useful. However, at moment only Pharmacy mngr and Mediphase have this facility.
johnep

Was just about to post a similar question - who has the final say in the dispensing transaction when a medicine is prescribe generically?

Can a patient demand a brand against a generic script?
Is the pharmacist bound to meet the patients request?
Other than vote with their feet and take their prescription elsewhere, what other options does the patient have?
Is this area covered in law?

All views welcome.

[Racer]

Re: Pt choice of brand of medication

Was just about to post a similar question - who has the final say in the dispensing transaction when a medicine is prescribe generically?

Can a patient demand a brand against a generic script?
Is the pharmacist bound to meet the patients request?
Other than vote with their feet and take their prescription elsewhere, what other options does the patient have?
Is this area covered in law?

All views welcome.

A patient can't demand a brand. It is entirely at the pharmacists discretion

[BBL]

Re: Pt choice of brand of medication

A patient can't demand a brand. It is entirely at the pharmacists discretion

Thanks for the reply - that's interesting. Is this recorded anywhere in guidance/law or is it just accepted practice?

In an age of patient choice/customer service this seems at odd with other intiatiaves/norms.

[Racer]

Re: Pt choice of brand of medication

It all comes down to money. No pharmacist is going to dispense Losec on a prescription for Omeprazole.

[BBL]

Re: Pt choice of brand of medication

It all comes down to money. No pharmacist is going to dispense Losec on a prescription for Omeprazole.

Fair point.

[johnep]

Re: Pt choice of brand of medication

Yes I have seen quite a few packs of an ethical go out of date while pharmacists dispensed the generic. Thsi would not happen so often if dispensary shelves laid out according to approved name.
johnep

[Racer]

Re: Pt choice of brand of medication

Yes I have seen quite a few packs of an ethical go out of date while pharmacists dispensed the generic. johnep

I'd give the ethical out in that exceptional case (and have done so) working on the principle of getting some money rather than none

[Pharmanaut]

Re: Pt choice of brand of medication

I'd give the ethical out in that exceptional case (and have done so) working on the principle of getting some money rather than none

If a product is new to the market then the generic prescription must be dispensed as the brand, because there is no generic available. After a time the product enters the drug tariff which lists the price the NHS will pay for scripts dispensed in a particular month. Then the brand 'comes off patent', and generic manufacturers go into production and cheaper alternatives appear on the market. The drug tariff price goes down to as the generics are cheaper. The brand price may drop a little.

If the prescription is written generically you get the price in the tariff. End of story. If the price in the tariff is a pound a packet and you dispense the brand at two pounds a packet - you only get paid a pound.

If a patient insists on a particular generic manufacturer most pharmacists will try to get that one for the patient and may even keep a few months reserved stock - that's customer service. However, no pharmacist would supply the brand on a generic prescription under normal circumstances. If the patient must have a particular brand the prescription would have to be changed to be written as the brand. Sometimes manufacturers may offer 'brand equalisation deals' whereby they will supply brand at generic prices - not sure how many of these are around at the moment.
Hope this helps and I get an opportunity to practice my touch typing with these long replies.

[luckydip]

Re: Pt choice of brand of medication

I have noticed that more patients are asking for particular brands of medication recently. PI's are being refused even though they are manufactured by the same company be it in Europe. I have had a few run ins with customers and usually I will order it in. In a few instances I have asked the customers to get the prescription written by brand to avoid these problems in the future.

I think in the future more and more people will demand certain brands and make our life hell.

[BBL]

Re: Pt choice of brand of medication

I have noticed that more patients are asking for particular brands of medication recently. PI's are being refused even though they are manufactured by the same company be it in Europe. I have had a few run ins with customers and usually I will order it in. In a few instances I have asked the customers to get the prescription written by brand to avoid these problems in the future.

I think in the future more and more people will demand certain brands and make our life hell.

...and this is the kind of scenario I was hinting at in my original question - I'm curious as to why this makes your life hell?

Put yourself in the patients shoes, you've been on a brand for a few years, get familiar with the pack layout, don't get side effects and then get told that all of that has changed - you begin to understand why some people would ask for their 'normal' medication. Just the same as if when you went to the pub and ordered your usual drink the barman randomly chaged it to another brand of beer - becaus they are all basically the same (ok, a weak example!)

[Raju]

Re: Pt choice of brand of medication

I'm curious as to why this makes your life hell?

With something like Bendro 2.5 (and most generics(, many companies make it. Pharmacists purchase from wholesalers which do not always have the drugs from the same companies, and cannot always, due to supply, problems ensure the same company's generic is always available. It makes a pharmacists life hell having to call 4-5 wholesalers to try and locate a specific comany's generic - when you know it contains the same active ingredient.

I wouldn't hesitate going the extra step to get the patient the same brand if it was always easy to do - but it sure as hell isn't.

The only time I do it is when there are therapeutic issues, e/g,

c/r anti-epileptices, c/r diltiazem, c/r nifedipine, e/c mesalazine.

(note in this case it isn't difficult to obtain)

Then I will always do it. Otherwise no way.

[Zoggite]

Re: Pt choice of brand of medication

I have patients who prefer generic zopiclone to Zimovane, and generic ranitidine to Zantac... They say they seem to work better; Anyone heard the same?
c/r anti-epileptices, c/r diltiazem, c/r nifedipine, e/c mesalazine: I will always try to get the surgery to switch to prescribing these by brand (good excuse for an intervention-prompted MUR!) and the LHB/PCT has published a list of "drugs that should not be prescribed generically" that include these, as well as beclometasone inhalers, Morphine tabs, fentanyl patches, and probably others that I can't recall right now.

[Jeff]

Re: Pt choice of brand of medication

I have patients who prefer generic zopiclone to Zimovane, and generic ranitidine to Zantac... They say they seem to work better; Anyone heard the same?

Of course - more often though it's a case of
"Could I have any generic except (insert make here) because that one brings me out in a rash."
"Could my generic medicine be one in a calendar pack because it helps me check if I've taken it or not"
"Could I not have (insert make of generic here) because I can't get through the packaging"
" Could I have the long scored version because I can't chop the round ones in half"

For the first I suggest trying to stick with one make of generic that suits with the fall back option of "any make except".
The last three may be reasons for considering MDS, repackaging from foil into bottles, or cutting tablets before dispensing.

IMO it's easier - and gives more control to the patient to say - "certainly" and ask for a couple of days notice in order to get the correct make into stock.

Jeff

[johnep]

Re: Pt choice of brand of medication

One good poit with Pharmacy manager is that it gives you the chance to specify a brand in the products folder so that this is reordered for a particular pt.
johnep