The gloves come off for ABPI and NHS fight
pharmafile | July 17, 2007 | News story | | ABPI, prescribing incentives
An unprecedented legal action by the pharmaceutical industry against the government could reach the High Court within the next few weeks.
UK pharma industry body, the ABPI, has been granted a judicial review over the issue of prescribing incentive schemes, through which many PCTs contain costs by paying GPs to prescribe cheaper medicines.
Over the last 12-18 months, primary care trusts and strategic health authorities have increased their use of incentive payments to doctors to switch patients off branded medicines to cheaper generic alternatives.
One high-profile example emerged last November, when Pharmafocus reported that the East of England SHA was ordering a mass switch of patients away from Pfizer’s branded statin, Lipitor, to cheaper generic simvastatin.
The government says such moves are safe and help create savings which can be diverted to other patients, but the industry claims the practice is frequently unethical, potentially dangerous and even illegal under European law.
The ABPI says it has been in discussion with the Department of Health since late 2006 over the issue, but has failed to reach an agreement and is now prepared to make its legal challenge.
The industry body says its lawyers have put together a strong legal claim against the use of incentive schemes, citing the European law which specifically outlaws payments from pharma companies to doctors.
ABPI spokesman Richard Ley said payments to doctors to directly influence prescribing should be considered illegal, regardless of who may be making the payment.
“It’s the thing that stops us bribing doctors – and it should apply to the government as well,” he said.
The ABPI is confident that the legal move will succeed, but the aggressive move against the government could backfire on the industry, potentially damaging its image just as the future of the UK medicines pricing system, the PPRS, is currently being considered.
A survey conducted by OnMedica on behalf of PharmaTimes, earlier this year, found the use of incentive schemes to be widespread.
The poll of 500 GPs found that two-thirds of respondent GPs reported that their PCT used a prescribing incentive scheme, and more than 75% admitted that it had influenced their prescribing behaviour.
In most cases, this meant prescribing cheaper drugs – 72% said that they prescribed fewer high-cost medicines because of these incentives.
A spokesman for the Department of Health said it would rigorously defend the challenge. It argues that the NHS could potentially save £84 million if patients with high cholesterol were switched onto generic versions of statins.
“These generic drugs are safe, of good quality, just as effective, and used to treat many millions of patients worldwide,” the spokesman said.
The Department also dismissed the grounds of the ABPI’s legal challenge, saying the European law in question does not apply to healthcare providers.
“The purpose of the legal provisions now contested by the ABPI is to control commercial activities, not the work of public health organisations.”
It concluded: “We are talking here about achieving best value-for-money for the taxpayer and are backed by authoritative guidance from NICE. Cost-effective prescribing releases resources for more patients to receive treatment.”
Meanwhile, the PCT Network, the group of managers which represents PCTs across England, has also registered its support for incentive schemes.
David Stout, director of the PCT Network, said: “We support the use of prescribing incentive schemes in PCTs which support clinical and cost-effective prescribing. These benefit both patients and tax payers.
“However, we would expect such incentive schemes to be in line with the recent good practice guidance issued by the Department of Health.”
The department has just issued updated guidance to the NHS on how to operate the schemes, laying greater stress on taking individual patient need into consideration and underlining that payments should be paid to practice funds and not to individuals.
Noel Staunton is an independent prescribing adviser to the NHS and the pharma industry and predicts that prescribing incentive schemes will remain, despite the industry’s legal challenge.
“I think its fairly clear that the outcome of this will be that PCOs will be allowed to pay GP practices to follow national guidance and to hit certain prescribing targets, but will not be allowed to pay per patient switched from one drug to another.”
Staunton says this will confirm the position that most PCOs have already taken, following a series of guidelines circulated by the MHRA and the Department of Health.
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