Global Insight Perspective | |
Significance | The Association of the British Pharmaceutical Industry (ABPI) has launched a judicial review of a policy that sees NHS doctors rewarded financially for increasing their prescribing of generic statins. |
Implications | The Department of Health (DoH) claims that the remuneration is not given to doctors directly but to their practices, and that annual savings of £84 million could be made. However, the ABPI says the move is tantamount to bribery and therefore against EU law. |
Outlook | Statins account for a major part of annual NHS expenditure, and the DoH will do its utmost to ensure greater savings in this area through greater use of generics. Yet while precedents in Europe do exist for encouraging greater generic statin prescribing, the financial reward part of the NHS scheme is unusual and could be subject to legal change. |
The U.K. Department of Health (DoH) is gearing up to defend in court its latest policy for cutting expenditure on the NHS, as the Association of the British Pharmaceutical Industry (ABPI) launches a judicial review of the scheme. The DoH's plan focuses on statins (anti-cholesterol drugs), and offers financial rewards to general practitioners (GP) who increase the percentage of generic statins prescribed as opposed to brand-name versions. While the DoH insists that the rewards will be made to the practice and not the individual GP, the ABPI claims that the payments are tantamount to bribing doctors for prescribing certain drugs, which is illegal under European Union (EU) law.
According to the BBC up to £84 million (US$169.3 million) could be shaved off the NHS's annual expenditure on pharmaceuticals, thanks to the gap in price between brand-name and generic statins. In the case of simvastatin, originally marketed under the Zocor brand by U.S. drugs giant Merck & Co, the generic version of the treatment is some £20 cheaper to buy than the branded original. However, the ABPI says that there is nothing to ensure that switching to generic drugs is being done in the best interest of individual patients rather than for financial gain by GPs. The association says that the DoH's guidance on the issue does not do enough to safeguard patients against this eventuality. As it stands, patients may object to being switched from a branded drug to a generic, and could be switched back. The ABPI, however, says that patients should give their informed consent prior to a generic switch being made.
Misdiagnosis Leading to Statin Overspend, says Study
The clash over prescribing generic statins comes just as a controversial new report on the drug class has been published in the British Medical Journal. According to The Guardian, the study finds that many doctors have been miscalculating people's risk of developing cardiovascular disease, resulting in frequent misdiagnosis and a subsequent over-prescribing of statins. The BMJ suggests that as many as 1.5 million people in the United Kingdom are wrongly informed they are at risk of contracting cardiovascular disease, unnecessarily inflating the annual public spend on statins, which are estimated to cost the NHS some £2 billion each year.
Outlook and Implications
The judicial review of the NHS rewards scheme for generic prescribing may well result in the Department of Health needing to make patients better informed and free to choose between brand-name or generic statins, but it remains to be seen whether the scheme will be eliminated altogether. Focusing on statins in particular—which are a therapeutic class with a high degree of generic penetration—there are several precedents for generic-substitution measures being implemented elsewhere in Europe. However, none as yet have included financial remuneration of GP surgeries as an incentive. In 2005, France's largest public health insurer, CNAM, demanded that all doctors prescribe generic versions of statins where they are available, with a goal of 80% generic substitution in the sector, while the number of statin-related marketing visits to GPs by drug-company representatives was slashed. In Germany, 2004 famously saw the inclusion of brand-name statins alongside their generic equivalents in the country's reference pricing list, ensuring that public spending on branded statins was forcibly lowered, resulting in a huge loss of sales for companies such as Pfizer (see Germany: 25 April 2005: Lipitor Sales in Germany Devastated by Reference Pricing Exclusion).
Anti-cholesterol drugs remain among the most frequently-prescribed medications in many Western European countries, making them an increasingly easy target for government cost-containment efforts. In the United Kingdom, the BBC reports that one-quarter of primary care trusts (PCTs) are already prescribing generic statins in over two-thirds of cases. There is obviously room for improvement here as far as the DoH is concerned, and it has been pushing for increased prescribing of generic statins since last year (see United Kingdom: 29 December 2006: Increased Prescription of Generic Statins Could Save U.K. NHS at Least US$167 mil.).