The news that the Health Service Medical Supplies (Costs) Bill received royal assent last month (April 28) is fantastic. Despite having one of the most competitive generics markets in the world, there are several examples of products where a lack of competition means the price of a medicine seems to be completely unrestricted.
With the Pharmaceutical Price Regulation Scheme not applying to generic drugs, removal of a brand name by a manufacturer previously meant that the price they could charge was no longer controlled, leading – in the worst case – to an increase of 12,000% in the price charged.
Medicines such as dicycloverine, alimemazine, carbimazole and trimipramine, have all experienced similar rises (see below).
Reference: * = May 2017 Drug Tariff, a = BNF 57, c = BNF 62
At a time when the NHS is struggling financially, and short-term gains like the senseless reduction in community pharmacy funding are sought, any money the NHS spends must be spent as wisely as possible. As you can see (above) the numbers involved are truly staggering and, until now, the NHS has been able to do very little about it.
Yes, local prescribing committees can make recommendations to GPs to ensure cost efficient prescribing. As a member of Cumbria’s area prescribing committee, I have worked to try to ensure this has been done.
Some of these medicines may have suitable therapeutic alternatives, that if used will not affect a patient’s treatment. However, this is not always the case – medicines such as trimipramine shouldn’t be switched without good cause, as this may be detrimental to a patient’s mental health.
Carbimazole is in a class of its own and medicines for similar indications – such as propylthiouracil – aren’t necessarily suitable, so prescribers may have no choice but to issue prescriptions for these items, despite the eye-watering costs involved.
The fact that the bill has received royal assent means the government can now intervene in circumstances where the market is failing, and stop drugs manufacturers exploiting precious NHS funds.
Ben Merriman is a community pharmacist working in Cumbria