Why does the NHS use expensive 'branded' drugs?

[Victor McDade]

Had taken the old man to the surgery today and whilst in the waiting room picked up a copy of the BNF, a book which lists which drugs are available to uk docs and at what cost.

What was apparent straight away was the huge difference in price between branded drugs and the generic version of the same thing.

For example, a particular cholesterol lowering preparation would cost the nhs 56p for 28 tablets of the generic version of the drug but would be almost £30 for the branded one.

Another example was medication for stomach problems: £2 for 28 of the gereric stuff and £30 for 28 of the branded ones.

So if the drug is chemically exactly the same why are docs allowed to prescribed the expensive stuff in the first place?

Is the expensive variant more effective?

Would be interested to hear the views health professionals who prescribe these drugs.

[wiffmaster]

Assuming a generic is available, it will always be prescribed. The books list all the drugs - if it's off patent, then the doctor will just go through and find the cheapest.

Assuming there's not a Use Patent of course...but they don't tend to exist/operate in practice.

[Sheets Tabuer]

If the Doc doesn't prescribe the generic he has to have a good reason.

They use software now to change the prescription to the generic drug

[db]

Fiat 124 or Lada Riva?
if anything is cheap, it's cheap for a reason.
the branded product will have had many years of testing and proof of efficacy. generic products will not have the same history. generic products will produced to the lowest cost, not the highest quality

[Defcon5]

db said:

if anything is cheap, it's cheap for a reason.
the branded product will have had many years of testing and proof of efficacy.

But the generc one is chemically identical.the active ingredient in ASDA ibuprofen is exactly the same as neurofen

[Paul Dishman]

db said:

Fiat 124 or Lada Riva?
if anything is cheap, it's cheap for a reason.
the branded product will have had many years of testing and proof of efficacy. generic products will not have the same history. generic products will produced to the lowest cost, not the highest quality

Not true. Generics are produced to the same standard and are equally as effective as the branded product.

The reason that the brand is more expensive is that it is usually produced by the drug company that developed the drug in the first place. The Research and Development costs in bringing a medicine to market are enormous, so the NHS will pay a premium price until the patent on the compound expires-usually 10 years. This gives the drug companies some reward and will encourage them to keep producing newer and hopefully better drugs.

[Paul Dishman]

Defcon5 said:

db said:

if anything is cheap, it's cheap for a reason.
the branded product will have had many years of testing and proof of efficacy.

But the generc one is chemically identical.the active ingredient in ASDA ibuprofen is exactly the same as neurofen

Correct

[anonymous-user]

I work in a pharmacy and most times they prescribe generic instead of branded drugs but the most stupid thing that pisses me off is when doctors prescribe gluten free breads/pasta. Apparently it costs £30 for one loaf when you add all the costs while the same bread costs £2.50 in our store (Tesco), most of the time they are prescribed in bulk so its even worse!

[Paul Dishman]

DoodoolTalla said:

I work in a pharmacy and most times they prescribe generic instead of branded drugs but the most stupid thing that pisses me off is when doctors prescribe gluten free breads/pasta. Apparently it costs £30 for one loaf when you add all the costs while the same bread costs £2.50 in our store (Tesco), most of the time they are prescribed in bulk so its even worse!

Its not £30 per loaf, a box of the fresh loaves costs about that for eight

[Broomsticklady]

I share eth views expressed on generic v branded - but some people have either real problems with generics or psychosomatic ones which 'force' their GPs to prescribe the branded versions.

The thread here talks about a hormone supressing breast cancer drug for post menopausal women which I take - I started on arimidex (the brand) and now take the generic (anastrozole) with no different problems - the main one being joints that require a mixture of paracetamol ibubrofen and tramodil to keep under control - but that's better than cancer so I don't moan too much! But as you'll see, lots of ladies disagree!

http://www.breastcancercare.org.uk/forum/viewtopic...

[MacGee]

Defcon5 said:

db said:

if anything is cheap, it's cheap for a reason.
the branded product will have had many years of testing and proof of efficacy.

But the generc one is chemically identical.the active ingredient in ASDA ibuprofen is exactly the same as neurofen

surely theres more than the chemical in the tablet...binding agents etc....so not all the same.

[Paul Dishman]

Broomsticklady said:

I share eth views expressed on generic v branded - but some people have either real problems with generics or psychosomatic ones which 'force' their GPs to prescribe the branded versions.

The thread here talks about a hormone supressing breast cancer drug for post menopausal women which I take - I started on arimidex (the brand) and now take the generic (anastrozole) with no different problems - the main one being joints that require a mixture of paracetamol ibubrofen and tramodil to keep under control - but that's better than cancer so I don't moan too much! But as you'll see, lots of ladies disagree!

http://www.breastcancercare.org.uk/forum/viewtopic...

Our GPs have only just switched to generic anastrozole so we haven't had anyone back with any problems yet. Time will tell, I suspect

[Paul Dishman]

MacGee said:

Defcon5 said:

db said:

if anything is cheap, it's cheap for a reason.
the branded product will have had many years of testing and proof of efficacy.

But the generc one is chemically identical.the active ingredient in ASDA ibuprofen is exactly the same as neurofen

surely theres more than the chemical in the tablet...binding agents etc....so not all the same.

The binding agents etc are all inert so the only difference might be in the colour or the coating of the tablet which is therapeutically insignificant. The generics are all tested and have the same physical characteristics- rate of dissolution of the tablet, absorption of the drug into the body, distribution throughout the body and elimination from the body as the original brand.

[mph1977]

there's a vanishingly tiny number of drugs where the there is a difference between brands these are well known and well documented.

once a drug is off patent it's price will drop even from the original maker for the drug in the branded box, we seem to rotate between different generic suppliers and the branded product at work (acute hospital) presumably based on the best combination of price and lead time at the point when the order is placed by our pharmacy ...

[db]

Paul Dishman said:

db said:

Fiat 124 or Lada Riva?
if anything is cheap, it's cheap for a reason.
the branded product will have had many years of testing and proof of efficacy. generic products will not have the same history. generic products will produced to the lowest cost, not the highest quality

Not true. Generics are produced to the same standard and are equally as effective as the branded product.

The reason that the brand is more expensive is that it is usually produced by the drug company that developed the drug in the first place. The Research and Development costs in bringing a medicine to market are enormous, so the NHS will pay a premium price until the patent on the compound expires-usually 10 years. This gives the drug companies some reward and will encourage them to keep producing newer and hopefully better drugs.

generics should be of the same standard. take nothing made in china, or anything made with a chinese manufactured ingredient.
my company used to buy vitamins from Roche (now DSM) until DSM changed the formula slightly, without notification. this caused us problems until we found out the formula had changed. after sourcing a new supplier we continued production until we had a visit from trading standards advising us the vitamins we were using were chinese made and contaminated with a banned substance.
i'll accept that vitamins are not drugs, but do not believe that all generics are manufactured to the same standard as branded products.

[Antonia]

Defcon5 said:

db said:

if anything is cheap, it's cheap for a reason.
the branded product will have had many years of testing and proof of efficacy.

But the generc one is chemically identical.the active ingredient in ASDA ibuprofen is exactly the same as neurofen

If my memory serves me correctly, Booker make Nurofen, Booker are owned by Boots, Booker also manufacture Boots own brand ibuprofen. So in this case I think you can be certain the products are one and the same.

[MacGee]

so it must be down to the manufacturers cashing in as much as they can before patent runs out. Thats business I suppose.

[Paul Dishman]

db said:

Paul Dishman said:

db said:

Fiat 124 or Lada Riva?
if anything is cheap, it's cheap for a reason.
the branded product will have had many years of testing and proof of efficacy. generic products will not have the same history. generic products will produced to the lowest cost, not the highest quality

Not true. Generics are produced to the same standard and are equally as effective as the branded product.

The reason that the brand is more expensive is that it is usually produced by the drug company that developed the drug in the first place. The Research and Development costs in bringing a medicine to market are enormous, so the NHS will pay a premium price until the patent on the compound expires-usually 10 years. This gives the drug companies some reward and will encourage them to keep producing newer and hopefully better drugs.

generics should be of the same standard. take nothing made in china, or anything made with a chinese manufactured ingredient.
my company used to buy vitamins from Roche (now DSM) until DSM changed the formula slightly, without notification. this caused us problems until we found out the formula had changed. after sourcing a new supplier we continued production until we had a visit from trading standards advising us the vitamins we were using were chinese made and contaminated with a banned substance.
i'll accept that vitamins are not drugs, but do not believe that all generics are manufactured to the same standard as branded products.

You're really talking about the difference between licensed medicines that have a product licence (look for PL ***/**** on the box) and a food supplement that isn't licensed. The process of licensing includes quality control and assurance that standards are met. There have been problems with imports and this is why the licensing system is in place and has been recently extended to include some products available from health food shops

[Paul Dishman]

MacGee said:

so it must be down to the manufacturers cashing in as much as they can before patent runs out. Thats business I suppose.

True, but they need the money to develop new drugs. Its an expensive business and the products can be sold worldwide so its been a good earner for the country. You have to take a wide view than the Daily Soovy-esque headline "NHS ripped off by Drug Companies"

[mph1977]

Paul Dishman said:

True, but they need the money to develop new drugs. Its an expensive business and the products can be sold worldwide so its been a good earner for the country. You have to take a wide view than the Daily Soovy-esque headline "NHS ripped off by Drug Companies"

the biggest scandal was the way in which the Drug companies used to try and induce GPs to prescribe the latest version of a drug rather than playing the cost=benefit game ... Proton pump inhibitors are a classic example , once Lansoprazole and Omeprazole came off patent varios 'new and improved' PPIs have been launched but it quietly forgets that for the majority of people lansoprazole or omeprazole or even ranitidine is more than adequate and peenies a month ...