One Size FIts All
Among baggage reclaim carousels across the globe, passengers are reuniting themselves with exactly the same luggage in one country as they so trustingly parted from in another.
News in Brief
| One Size FIts All |
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| Written by Laure James - Editor Pharmacy in Focus | |
| Thursday, 24 February 2011 09:18 | |
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Among baggage reclaim carousels across the globe, passengers are reuniting themselves with exactly the same luggage in one country as they so trustingly parted from in another. In theory the Board’s new policy on prescribing standardisation across primary and secondary care should make sense – a patient is discharged from hospital having been prescribed a certain drug therapy and will continue to be prescribed exactly the same formulation by their GP. The Board has recently completed a tender process with a number of manufacturers and written to pharmacists and prescribers advising which branded generics are now considered to be the “preferred” choices. For instance, whenever calcium and vitamin D is indicated for new patients, Natecal D3, a preparation manufactured by Chiesi has been named as the Board’s preferred brand for dispensing. Natecal D3 is of course just one of a string of those which have successfully tendered for the Board’s approval but as an example, what has Chiesi’s involvement with the Board been to date? Which criteria did the brand have to meet for the decision to be made and has the company offered fixed pricing and if so for how long? “Chiesi have been fully engaged in the HSCB tending processes for their Product Standardisation policy across both primary and secondary care, however the terms of any agreements we have reached within this tendering process are obviously confidential,” a spokesperson for the company explained. “I can however confirm that the NHS list prices of all our products included within this tendering policy remain unaltered and as such retail pharmacists in Northern Ireland are still able to purchase all Chiesi products at the same prices and on the same commercial terms from their existing wholesale suppliers as previously.” Morningside Pharmaceuticals has also come up trumps following a tender process with its drug Vensir XL, noted as the preferred brand for whenever venlafaxine capsules or tablets are indicated. As the company’s director Danesh Gadhia told PiF however, there are still a few loose ends to tie up. “Morningside is still in discussions with the HSC and so it would not be appropriate for us to make any comments at this stage,” he said. “PCC are taking a very close look at the roll out of the standardised prescribing guidance within primary care, which we understand involves a policy of prescribing specific branded generics selected as the result of DHSSPS secondary care linked to primary care tender processes,” PCC chief executive Gerard Greene told PiF. “The news has sent shockwaves throughout the community pharmacy network in Northern Ireland and what may appear to be an innocuous initiative involving the Board making recommendations to GPs to prescribe specific branded generics instead of the true generic, in reality represents a step change in policy which will land multiple problems in the lap of community pharmacists. “It should be noted that the adoption of a policy recommending that GPs prescribe specified branded generics is at variance not only with the Department’s own Go-Generic policy but is also at variance with prescribing policies elsewhere in the UK where other Departments of Health recognise the numerous disadvantages associated with branded generic prescribing. Such dangers are well documented in the pharmaceutical industry and include supply chain problems, significantly increased administration and bureaucracy for community pharmacists, stockholding problems, increased costs in administering multiple accounts, increased medium to longer term NHS costs and immediate funding implications for community pharmacy. These are problems which do not appear to have been considered by HSCB.” One of the key considerations which the Board and the Department appear to have overlooked with this new Northern Ireland policy is the negative impact that moving from a generic acquisition and re-imbursement model to a branded generic acquisition and reimbursement model will have on community pharmacy funding. It is accepted by DH (England) and SEHD (Scotland) that community pharmacies derive a critical element of their funding from generics in order to subsidise the provision of services – accordingly in England/Wales and Scotland ringfenced quantums of money from generic purchases are recognised and allocated within their funding arrangements. While DHSSPS/HSC acknowledge that this should also be the case for Northern Ireland the decision to go ahead and implement the policy is worrying and the timing of the introduction of a policy promoting the prescribing of branded generics - during new contract negotiations – could not be worse and will have a serious impact on the community pharmacy finances. This appears to have been ignored by HSC and DHSSPS and the apparent absence of carrying an impact assessment on the adverse effects such a change will have on community pharmacy etc is contrary to normal consultation practices associated with policy changes. Community pharmacists play important roles within the NHS in helping to exert downward pressure on the cost of generic medicines through their effective sourcing of drugs and they also play an important role in ensuring patients obtain the maximum benefits from medicines supplied. A very short term perspective is being taken in Northern Ireland with this branded generic policy, a policy that will impact on the patient, the NHS and community pharmacists. Where GPs continue to prescribe a freely available generic drug, the community pharmacist is free to dispense the generic of their choice and to seek re-imbursement based on the generic version in accordance with the GPs instruction. It is only when the GP prescribes a branded generic that the branded version prescribed must be dispensed. Stock shortages have already been raised as very real concerns among contractors and John McArdle, general manager at Bradleys Pharmacy has already identified a possible difficulty. “One of the specified brands is Contiflo (tamsulosin), manufactured by Ranbaxy,” John began. “The manufacturer will charge £10 per item, per order unless the value of the order is over £25. The drug tariff price for this treatment is roughly £1.10 so it would mean stockholding a considerable volume of drugs to benefit from free delivery as an average community pharmacy would definitely not consider tamsulosin, especially a particular brand, as a fast moving line.” However, John highlighted that there is a way around this. “Carriage is considered an out of pocket expense for contractors ordering in medicines so therefore it is possible to claim reimbursement for this through BSO,” he observed. “Surely this undermines any cost cutting the Board are trying to achieve and, given that this particular policy will cost the health service money, I wonder if the actual costs have been accurately estimated? The risk here is that it will be a lot more costly than the Board thinks.” The issue of product standardisation is also a key concern of the Ulster Chemists’ Association. “Over the past year there has been a substantial increase in the number of problems that contractors are experiencing in obtaining certain branded medicines,” explains pharmacy contractor Jonathan Lloyd. “The introduction of product standardisation will limit the choice of product available to pharmacists to dispense and the UCA fears that this will lead to further supply issues. “Rather than sourcing medicines from their usual wholesaler pharmacists will have to spend more time ordering these medications from various manufacturers which will add to an already burdensome workload as pharmacists will have to go to extra lengths to ensure patient's supplies are maintained. The Department of Health has recently stated that medications should be received by pharmacies within 24 hours of the order being placed. With the new prescribing policy some of the standardised medicines will have a lead time of three working days which the UCA feels is a less than ideal situation.” A spokesperson from the RQIA told PiF that since the guidance is primarily aimed at GPs and pharmacists, they would be unable to make a comment relating to the clarity of the guidance but had noted the Board’s circular. “The RQIA believe that the onus is upon GPs to follow the prescribing guidance which comes from the Board,” the spokesperson said. “Our involvement in the management of medicines in nursing and care homes is that if someone has been prescribed a particular dosage, that it is administered appropriately, whether they receive a generic or a proprietary drug. We would want to ensure that the patient receives the same level of care regardless of the drug they have been prescribed. We see this particular guidance as purely a matter between the GPs and the pharmacists who are dealing with the prescriptions. We would have no direct involvement. There is quite a number of guidance notes which are issued that are of particular relevance to RQIA and others which are purely for information. This is an example of the latter.” |