The growing debate over generic substitution has taken another turn after research with patients on antihypertensives indicates that it could actually potentially raise overall treatment costs.

The government is currently considering the implementation of automatic generic substitution throughout the National Health Service, whereby pharmacists can substitute a doctor’s prescription for a branded medicine for a cheaper generic version in a bid to save some cash.

However, a study by researchers investigating the effectiveness, safety and cost of drug substitution specifically in hypertension, published in the British Journal of Clinical Pharmacology, found that the acquisition of the medicine alone is not the only cost to be considered.

A large variety of other factors must be taken into account when assessing the potential impact of switching patients with hypertension onto a different medicine, including the expense of extra clinic visits and laboratory tests, as well as hospital costs should the patient suffer any side effects from the newly-prescribed generic or the condition is no longer adequately controlled, for example.

“Although the cost of treatment should always be considered, careful assessment of the human and economic costs and benefits of antihypertensive drug substitution is required before this practice is recommended,” the researchers stress.

The government is currently consulting the introduction of automatic generic substitution in the NHS, even though 83% of all prescribing in the health service is already for generic medicines, but its plans have come under heavy fire from both the industry and healthcare professionals.

According to the Ethical Medicines Industry Group, in a recent survey of its member companies, 85% said they would like to keep the prescribing situation in the NHS as it is, while a recent poll by found that the majority of doctors - 76% - are opposed to the principle, indicating strong resistance to the proposals.

Greater risks?
According to the EMIG, automatic generic substitution will expose patients currently prescribed branded products for specific conditions to “unnecessary additional risks for little or no clinical benefit”.

The National Pharmacy Association has also voiced its objections to the move. “We believe that changes to a generic from the brand must be instigated by the prescriber, and the patient must be involved in the decision,” says Margaret Peycke, external relations manager at the NPA.

The group has called on the Department of Health and the NHS to target prescribers with low levels of generic prescribing, “rather than asking the pharmacist to intervene, which could potentially damage patient or prescriber relationships”.