Rick Seymour

Generic Prescriptions By Default

Doctors (GPs) can prescribe drugs either in their generic (pharmacological) name or under a branded (drug company) name. This solution is to make drugs prescribed by the doctor and issued by the pharmacist to be “Generic by Default”, it has innovations in the primary care computer systems but a large social change also.

What is the difference in cost between a branded and a generic prescription to the NHS? (Source: BNF 61)

Ramipril (Generic)

Tablets, 1.25 mg, net price 28-tab pack = £1.71

Tritace® (Sanofi-Aventis)

Tablets, scored, 1.25 mg (white), net price 28-tab pack = £5.09

So a doctor writing a branded prescription for this blood pressure tablet costs the NHS THREE TIMES more than a generic prescription. Currently a GP using systems like EMIS/Vision is presented with a generic option but can still select a branded product.

Current UK Prescription Charge = £7.20 per prescription

The Solution

I propose a simple shift change in the prescription charging system that ensures that patients are as much put in the driving seat with their prescribing by charging DIFFERENT AMOUNTS for generic vs branded products……

For example

If a patient wants Tritace they would pay £7.50… if they wanted Ramipril they would pay a STANDARD prescription charge of (say) £6.80 per prescription. I.e. Less for a generic product. If a patient is asked to pay more for a product than the standard charge then they are VERY LIKELY to ask the question “What is the difference between Tritace and Ramipril?” Answer…. nothing.

Everyone makes a contribution

Also the monies payable to the doctor and the pharmacist would be reduced for a branded product…. therefore the increased cost of the drug are shared equally between the patient, the doctor and the pharmacist.

Primary Care Trusts to GP Consortia

With the move from PCT to GP consortia the NHS really MUST re-look at prescribing. A GP with an attached pharmacy is a license to print money! Also as PCTs are disbanded the PCT “Clinical Pharmacist” role will be scrapped, who’s role is to go around GPs and ensure that drugs are prescribed in the generic and not the branded form and to save the NHS money. (Amongst other cost saving work)

Technological Changes

This solution would require EMIS, Vision and primary care software providers to make changes to their systems:-

  • to only provide generic drugs by default and to show the prescribing GP the increase in cost to them for prescribing a branded product
  • to link better with pharmacies to SPINE
  • to provide NHS with live prescribing information

Other changes technologically

  • Make the BNF public
  • Open Data from GP & Pharmacies.

Include prescribing indicators, outcomes, dispensing NHS should work with (but not pay for) these healthcare providers to ensure that they are given plenty of warning about the changes they will HAVE to provide.

Summary

This problem/solution is not about creating another £4bn IT monster, but small changes in primary care systems and a culture change between NHS and patient.

Taken from – https://dotgovlabs.direct.gov.uk/Page/ViewIdea?ideaid=1545

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