A multidisciplinary group of experts and patient bodies has endorsed a new report which calls into question the proposal to automatically substitute branded medicines for cheaper, copycat versions where possible, thereby removing doctors’ freedom to choose which drugs best suit their patients.

The Department of Health plans to introduce automatic generic substitution from January next year as per the Pharmaceutical Price Regulation Scheme in a bid to drive down the National Health Service’s drugs bill and save cash, but those opposing the initiative claim that not only could it actually increase costs but also put patient safety at risk.

According to the report - compiled by CancerBACUP, the Primary Care Dermatology Society and the European Parkinson’s Disease Society and funded by European specialty pharma Norgine - the proposed new dispensing regulations, under which pharmacists are required to automatically switch branded medicines prescribed by doctors for generic versions unless otherwise directed, could lead to patient confusion and therefore impact on adherence and, crucially, result in poorer treatment outcomes.

In addition, the policy could even lead to switches between generic medicines, which come in a variety of sizes, shapes, colours and packaging, so patients could be dished out a different version of their treatment on each visit to the pharmacy. But, as the report claims: “Switching between medications has been shown to significantly reduce adherence to treatment, and it is known that poor adherence is associated with worse outcomes and increased costs for a variety of conditions”.

Differing reactions
Furthermore, while the active ingredient is the same in both branded drugs and their generic counterparts, the products are by no means always identical. Various substances are used to ‘bulk-up’ medicines and patients can react differently to these, which could lead to side-effects from one form of treatment but not from another, and this could potentially disrupt the management of serious illnesses, the report points out.

Ultimately, it should be at the discretion of doctors to decide which medicine to prescribe for their patients, given that they are familiar with the patient’s medical history, the report stresses, and it calls for a public consultation on “the practical impact of generic substitution on patients adherence and outcomes and the potential impact of varying bioavailability on outcomes and adverse events”.