Forum

RIP-OFF?

All my medication (apart from Copaxone) comes from the High Street pharmacy who have a branch attached to my GP surgery.

Finishing a packet of Gabapentin this morning, I reached for the bag of medications that I collected on Saturday. There is nothing else packed in the same size box, so I did not look at it until it was on my desk.

Sure enough, it was Gabapentin, but the box was a different colour and typeface.

  • The “old” supply was from a large drug manufacturer and had a brand name (Neurontin) with Gabapentin in much smaller lettering.
  • The “new” packet was marked Gabapentin and came from a manufacturer of generic drugs.

So, I reach for a copy of the BNF, and look at the price - Branded is 9 (yes, Nine) times the price of Generic.

That give rise to several thoughts:

  • The budget that all GPs have for medication has been hit quite hard just for me. So multiply it a few thousand times, and how many people have not had the best medication because of this.
  • In percentage terms, the profit on each product will likely be the same - but the difference in turnover will be substantial.~
  • That in turn will affect the “Return on Capital Employed” which is a key figure that gets looked at when there is a takeover in the offing.
  • So I do a quick Internet search - and find that a takeover deal has just been agreed for that High Street chain.

I don’t pay for my medication (too old) and the current prescription charge would recover the cost of generic Gabapentin - but would go no-where near the Branded price. So ultimately, it is the NHS that have been getting ripped off, with a possible effect on all of us. The remaining question is, of course, the big one - who in authority should have been checking on this?

PCTs do usually keep an eye on these things. Normally drugs can only be supplied by the initial manufacturer for 7 years to give them time to recoup some of the cost that goes in to research and development. After that the generic companies can come in.

I know that my PCT regularly sends lists to GPs saying when things are past the 7 year mark and can be prescribed generically.

Having a background in pharmacy [sometime in another lifetime] I know that GPs have been told to prescribe using drug names instead of brand names for a long time - and if they don’t they get a visit from the prescribing police!!

Liz

Hi, throughout the 13 years Ive been prescribed drugs to help ease the MS like symptoms I have, there have been times when Ive noticed the packaging on this or that drug has changed.

In the past, I have rung the chemist to check it is actually the right drug I am supposed to have. The chemist said how observant I was, but yes, the drug is fine.

My own meds must cost a small fortune, as i`m on so many.

One thing which constantly annoys me is that one particular med…candesarten for BP… has 1 sleeve of 7 pills to one cardboard packet. All my ohter drugs boxes contain a months worth of pills. What a complete waste of packaging for the candesarten, eh? I mean, its not as if anyone is ever prescribed 1 week`s worth of the drug.

luv POllx

Agree with efb, that the license is for 7 years. In hospitals they do tend to keep an eye on when the license runs out and change to the generic version. They only way they can stay with a certain branded one is if they can justify its use.

You would have thought that the PCTs would check, would you not.

My PCT (in debt) was formed by merging two others (each about £11 million in debt). The Chief Executive went on to a better post (gosh, what a surprise).

My prescription always has a name on it (in fact all the medications are named as such) so the pharmacy has been supplying a brand to fill a named prescription. I gather that there was a shortage of Gabapentin in early 2010, and “special dispensation” was given to supply the branded product (it really is great what you can find out on the net if you use the right words) but Two and a Half years does seem to be a long time to sort a supply out.

The words that come to mind are those like “Complacency” and “Incompetence”. Meannwhile, the NHS remains short of money.

Geoff

If you have been given Neurontin instead of a generic gabapentin it is the pharmacy that has lost out - they will only be paid the cost of the generic.

Liz

They do come in larger packs - obviously this is the one your pharmacy gets the best deal on.

Liz

Oh right. Thanks for that.

luv Pollx

My naive point of view is that some drug companies are deeply entwined with Government and various Home Office Departments and have been for years. There is more tax revenue on more expensive drugs and for anybody massaging the figures,the more massage the better.

Lots of facts and figures regarding Fat Pharma came out 3-4 years ago during the ‘LDN Civil War’.The donations to the MS Society with figures came out from one of the management team,and very interesting reading it made when the whole LDN story was looked at.

Wb

One question that is rarely raised is the bioavailability of generic drugs, which can vary widely from the brand drug but still be within the limits of the law. Of course, I understand the cost issue, and that the big pharma companies have to cover costs of extensive R & D, but one must never forget they are corporate entities and thus all about the money not the morality.

This is so ironic! As I have epilepsy I use an epilepsy forum. This issue is huge for people with epilepsy because although, bioavailablitly DOES NOT vary widely from brand to brand, if you are on a knife edge to keep seizure control it is theoretically possible that changing brands can provoke a seizure.

This issue became huge because Lamictal came off patent most of us had our repeat prescriptions changed from Lamictal to lamotrigine so save huge ammounts of money. NICE has decreed that epilepsy is one instance where the person being prescribed it to control seizures MUST remain on the version they are stable on. For me, that’s Lamictal.

For MS treatment I don’t think changing from one generic version of gabapentin to another makes any appreciable difference. It is a drug used to treat epilepsy so anyone taking it to maintain seizure control should have been kept on the ‘original’. So make sure you are prescribed gabapentin!

The system of licensing has been around for many many years and I don’t see it changing anytime soon! It can take over 10 years to take a medicine from the test tube to market and costs millions of pounds so drugs companies like to be able to recoup their costs and make a profit withing the first 10 years of them telling the world about it! That is years before anyone knows if it is effective for treating patients and getting a license to sell it. Some drugs have been prescribed before i has been dotted and t crossed to try and speed up the process, on the understanding that, amongst other things, the patient may be affected by unknown side effects. Sativex is one example of a drug being prescribed sometimes to treat conditions as licensed.

I assure you, bioavailability/equivalence is not limited to anti-seizure medications, though this is the most prominent example. Many subclasses of drug / sub-populations are cited as “approach substitution with caution” - theoretically anything with a narrow therapeutic range can be affected. Not that I mind generics, although I do seem to need brand Efexor (all generics, so far encountered make me throw up - of course, this may be inactive ingredients, but delivery of drug and suitability for a range of recipients should be considered when discussing bioequivalence)

Loosely defined, regulations state bioequivalence is achieved if a 90% confidence interval of the mean between the generic : brand is within 80 - 125%. In other words, “close enough most of the time”

I have my drugs delivered and sometimes have cheap versions of my drugs especially Movical. I was talking with a friend who is on the Butans patches and he tells me that they the chemist has issued him with a cheaper drug and they do not work and have left him in agony, (He had a car accident that damaged his spine), his doctor has had to make a stipulation to the chemist that he is only to have the brand name. I look out for this now as I am aware that I could be supplied with an inferior brand of drug. My friend says it’s because he is on benefits, don’t know if this is true. I pay up front every year for my prescriptions and still have inferior drugs sometimes.