PCTs increasingly ‘red list’ drugs to cut costs
pharmafile | May 12, 2011 | Feature | Sales and Marketing | GP prescribing deicisions, GPs, PCTs, prescribing
GPs are being asked not to prescribe NICE-approved drugs in order to cut costs.
In the last year more than half of all primary care trusts have brought in new ‘red lists’ advising GPs not to prescribe certain drugs, according to a Freedom of Information Act request by GP magazine Pulse.
These restrictions cover many NICE-approved drugs, including some DPP-4 inhibitors for diabetes, the blockbuster statin Lipitor developed by Pfizer, and AstraZeneca’s Crestor.
Also among the drugs in the list is Amgen and GlaxoSmithKline’s Prolia for osteoporosis.
A spokeswoman for GSK, Sarah Hornby, said the company found it frustrating to come up against such a block when the drug had already been approved through the necessary channels.
In a joint statement issued to Pharmafocus, Amgen and GSK said they were not aware of any red list for Prolia, but knew that 39% of PCTs have restricted administration of Prolia to hospitals only.
Both companies said this was inappropriate as most patients with osteoporosis are treated by GPs – as recommended by NICE – and this is in fact cheaper than treating them in hospital.
In an emailed statement AstraZeneca said it was concerned about widespread red listing being used to make ‘drastic’ savings on prescribing budgets.
The company added that restricting GPs ability to prescribe on cost grounds alone was ‘inappropriate and inconsistent’ with established prescribing guidance. Other drugs have also been red listed on the basis of ‘low clinical priority’, including drugs for Parkinson’s disease, newer contraceptive pills, erectile dysfunction drugs, and Roche’s weight-loss drug Xenical.
Paul Catchpole, value and access director at the ABPI, said he wanted to see red lists and black lists become a ‘thing of the past,’ and would continue working with the Department of Health and the NHS to improve relations between industry and healthcare professionals.
The red lists are a result of GP practice requirements to meet new quality and productivity targets, and the wider need to meet £20 billion in efficiency savings by 2015. The trusts say they hope this will help make savings of around £250 million from this year’s drug budget alone.
Growing red lists
Responses from 134 PCTs under the Act show that more than half have red lists of drugs that GPs are advised not to prescribe. Cambridgeshire PCT said its red list now covers more than 100 drugs that will “not be normally funded for prescribing in primary care”. Milton Keynes PCT has moved toward a zero tolerance policy, saying it intends to levy a fine against GPs that request the prescription of a red listed medicine.
Some PCTs are going even further by encouraging GPs not to prescribe medicines at all for some conditions – instead recommending other options such as weight loss and nutrition advice.
David Stout, chief executive of the PCT Network, said: “We will probably continue to look at the cost-effectiveness of every aspect of healthcare, including prescribing, because we need to get the best possible value for money out of the limited funds available to the NHS.
“I would hope that most people would agree with that,” he added.
NICE declined to comment on the plans but a Department of Health spokesman queried the lists, telling Pharmafocus: “There are ways to make efficiencies and increase productivity without cutting back on drugs which have proven to be effective. The problem is when people look for easy cuts without thinking outside the square, or thinking of more innovative and creative ways to make savings.”
The DH stressed the PCTs advice was not binding on GPs, who remain obliged to consider NICE guidance when prescribing.
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