Posted on 01 August 2012
Sick elderly people (as well as doctors) will be the first victims of the Spending review. Let's see why.
The new rule would provide that the doctor MUST prescribe only the active ingredient of the drug and not the trade name, except to justify the thing, in the recipe, with a "synthetic motivation".
The new text appears even WORSE compared to the proposals previously launched, and does not seem to demonstrate any real utility except, perhaps, for a few interested people…
The previous proposals had aroused considerable (and motivated) controversy, essentially focusing on some highly questionable aspects:
1) The different composition of the excipients between "equivalent" generic drugs for which "wild" changes could have harmed patients allergic or intolerant to some of them. The new rule leaves them almost defenseless. (see note 1).
But in case of adverse events, who will be responsible?
2) The problem of bioequivalence for which, as now unquestionably recognized, two generics with the same active ingredient are "bioequivalent" with respect to the reference designer drug but are not necessarily bioequivalent to each other. (Note 1)
3) Compulsorily prescribing generics does not bring any savings to the NHS as with the previous regulations the cost for the latter is always the same and the difference is borne by the individual citizen who, however, is free to claim the generic or the brand name drug. A freedom that does not cost the State anything, and it is not my affirmation, also having the support of the Council of State (Section III, October 27, 2011, n. 5790) which underlined the uselessness of a regional law which forced the doctor to indicate only the generic as the region did not achieve any advantage as the reimbursement of the cost of equivalent drugs paid by the health service is always the same, and is legally predetermined. (Note 2)
The MANDATORY prescription of the active ingredient alone then entails further serious problems:
1) The continuous wild change of the packs dispensed to the patient. It is known to all how many elderly patients follow the therapies recognizing the drugs by the color of the box or de