This is a PatientPlus article. PatientPlus articles are written for doctors and so the language can be technical, however some people find that they add depth to the patient information leaflets. You may find the abbreviations record helpful.
In March 2004 it was announced by the Chief Medical Officer that the names of medicines would be simplified with the aim of reducing the risk of error in the prescribing and dispensing of medicines.1 The simplification referred to the change from the ‘British Approved Names’ (BANs) to the international system of ‘recommended International Non-Proprietary Names’ (rINNs). For example bendrofluazide (BAN) becomes bendroflumethiazide (rINN). A full list of names affected can be found on the Medicines and Healthcare products Regulatory Agency (MHRA) website.2 Some software systems have taken more than 2 years to adopt the new nomenclature.
- Generic prescribing of simvastatin
- Generic prescribing of proton pump inhibitors
It is widely appreciated that rates of generic prescribing need careful interpretation when passing judgement on the quality of prescribing.
- Where there is a particularly narrow therapeutic index. For example:
- With modified release preparations such as:
- With compound preparations, for example:
- Oilatum emollient
- With certain combined preparations, for example:
- When the same drug is used for different and separately branded indications, for example:
- Indoramin used as Doralese® (20 mg od or bd) for urinary incontinence and as Baratol® (25mg) for hypertension.
- When the same drug is formulated to give different potency, for example:
- Qvar®, CFC free inhalers. A 100 microgram dose of Qvar is equivalent in potency to 200-250 micrograms of beclometasone by CFC-containing inhaler.
- Generic prescribing rates are much higher in the UK than many other countries. Efforts in other countries are being made to increase rates of generic prescribing often as part of efforts to improve the quality and efficacy of prescribing.7,8,9
- Patients’ concerns about generic prescriptions are very common and often centre on the perception that cheaper drugs may be inferior.10 One study from France, however, reported lower levels of acceptance of generic prescribing amongst general practitioners when compared with pharmacists and the general public.11 A study amongst French ophthalmologists showed an acceptance of the equivalence of generic prescriptions for glaucoma but this did not translate into the issuing of such a prescription because of lack of concern over cost.12
- Confusion over brand names is also an issue and education by prescribing doctors, dispensing pharmacists and manufacturers is important.13
- The scope for cost saving is greatest in countries with low rates of generic prescribing.8 In the UK the scope for big cost savings is correspondingly much smaller. Incentives to prescribing physicians are suggested in countries with low rates of generic prescribing and have certainly been used in the UK.8
- Concerns over the therapeutic equivalence of branded products and generics are common amongst physicians too.14 This is true in areas of prescribing where equivalence is critical such as with anticonvulsants and anticoagulants.14,15,16
- A recent study concluded that cheaper generic statins were as effective at achieving QOF targets as more expensive alternatives.17
- More savings might be made with generic prescribing with improved management of the purchasing of generic drugs by the NHS.18