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New drive to cut millions from branded sales on NHS

Published on 03/11/06 at 02:17pm

Some of the UK's top selling medicines are to be targeted in a new NHS drive to cut millions from the prescribing budget, with initiatives to be launched by the Department of Health and at a local level.

In what is thought to be an unprecedented move, the newly formed East of England Strategic Health Authority has announced plans to have 80% of patients on statins taking a generic version (usually simvastatin) which is around six times cheaper than the branded versions.

The SHA says the move will save it £23.8 million, and allow it to free up money for spending elsewhere.

But Pfizer, whose Lipitor is the market-leading branded statin, has reacted strongly to the news. Dr Kate Lloyd, Medical Director of Pfizer UK, said: "This target of 80% is likely to put some patients in Eastern England at risk. Pfizer has already challenged the recently introduced Department of Health target of 69% generic statin prescribing, as being at odds with optimal clinical care. Pfizer will now ask the DH if it is content that this higher target of 80% is reconcilable with the best care for patients.

"Pfizer acknowledges that there is a funding crisis in the NHS; however, patient care should not be compromised by this cost-cutting exercise."

Meanwhile, the Department of Health has confirmed that its Medicines, Pharmacy & Industry Group (MPIG) is actively looking at introducing targets for generic prescribing to new areas. These are thought to include angiotensin II receptor blockers (ARBs), combination inhalers, anti-inflammatories and proton-pump inhibitors.

Noel Staunton of 3i Consultancy, who works for both the industry and NHS bodies, says he was passed this information by an DH insider.

He commented: "You can bet your bottom dollar that in six months' or a years' time, large chunks of off-patent drugs will be targeted by a government determined to cut down on costs.

A Department of Health spokeswoman confirmed targets were being reviewed, telling Pharmafocus: "We are continually considering what further opportunities may be available for improving productivity."

But she added no final decisions had yet been made.

Figures from the Department of Health show the overall percentage of prescriptions written generically in the UK rose to 80% in 2005. This rate is higher than anywhere else in Europe, and has risen every year since 1994.

But after years of growing budgets, the squeeze is now on in all areas of NHS expenditure, and the government and its newly reorganised strategic health authorities and primary care trusts are focusing on value for money.

Noel Staunton says the angiotensin II receptor agonists class of blood pressure drugs will be the first to be targeted under the DH-led scheme.

Despite not being recommended by NICE for the majority of patients, £224 million was spent on the drugs across this class in England's primary care sector last year. This figure is higher than the bill for older ACE inhibitor drugs, even though three times as many prescriptions of these were dispensed.

The newer drugs, including Merck Sharp & Dohme's market leader,Cozaar, have been successful because of greater efficacy claims over older generic drugs  but if NICE guidance is strictly enforced, sales growth of the drugs would stall or could even go into reverse.

Meanwhile, Pfizer's Lipitor is by far the UKs biggest selling medicine, with GPs in England prescribing nearly £400 million of the drug in 2005.

This figure accounts for nearly two thirds of England's overall bill of £625 million for lipid-lowering drugs in 2005, and makes an obvious target for NHS managers looking to cut costs.

Commenting on its new target, East of England SHAs director of commissioning, Dr Paul Watson, said: "We must ensure we use NHS funds carefully and concentrate our spending where it can do the most good.

"By encouraging GPs to make the switch, we expect to make significant savings, increase value for money and release much needed resources to other areas of the health service - all of which will benefit patients in the long term."

But a spokesman for the ABPI said it was gravely concerned about the continued push towards generic prescribing  and warned it would lead to a severe reduction in R&D initiatives within the industry.

He said the association was fully aware of the statins situation and had been in constant talks with the government over the past three months. "We are at the start of a very long debate," he said.

He added: "This news of extending generic prescribing is even more worrying. In a sense, blanket switching of statins is relatively easy as they are in a class of medicines with no other health concerns.

"If what you say is true, these other targets are a different kettle of fish. This will be much more dangerous territory in terms of providing guaranteed, safe and effective patient care."

The government recently announced that NICE is to review use of ineffective treatments by the NHS with the aim of saving millions of pounds - money it says could be reinvested into other, more effective medicines and new clinical procedures.

Earlier this year, the chief medical officer highlighted wasteful NHS spending on established procedures with no proven value, such as the £21 million annual cost of unnecessary tonsillectomies and hysterectomies.

No official announcement regarding whether or not any branded medicines will be considered ineffective has yet been made, but enforcement of some existing guidance, particularly on the use of statins and other cardiovascular drugs, would result in considerable savings.

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