4 ms·

Where I live doctors are only allowed to give prescriptions for the generic chemical compound and are forbidden to give prescriptions for specific brands. They

by olvar_ 8y ago

Where I live doctors are only allowed to give prescriptions for the generic chemical compound and are forbidden to give prescriptions for specific brands. They may suggest the use of a particular brand if they know of a benefit over others but the one who decides is the patient. Of course this is not very useful when the drug is patented or if there is only one laboratory producing it, but none the less it seems like a sane default. And this is in a private healthcare system, it is surprising that the NHS doesn't have a rule like this when is their taxpayer's money being used.

makomk 8y ago
The cheaper alternative that the NHS wants to offer is not actually the same as the more expensive drug that's licensed to treat wet age-related macular degeneration. It's related and there's every reason to believe it's as safe and effective as the licensed drug, but it's still not the same stuff.
- gerdesj 8y ago
  The cheaper one is 3.5% and 5% the price of the other two and is recommended by WHO and used widely around the world, including the US. As always the decision as to what will be appropriate will lie with the doctor but at least they have the option now. I expect that the price of the other two will mysteriously drop quite dramatically now ...
  - candiodari 8y ago
    Yes but there's 2 issues: 1) not in the same concentration/dose (patient will need to change the dose by breaking pills) 2) not according to the UK government (which has never approved the cheaper drug) So now the big question is, suppose this goes very wrong for a patient, who is responsible ? The doctor ? The patient ? The government ?
    - jaclaz 8y ago
      >1) not in the same concentration/dose (patient will need to change the dose by breaking pills) Specifically I don't think they are using pills (untouched or broken) to make intraocular injections.
dekhn 8y ago
this is a more complicated situation. First, for biologics, there are rarely equivalent generics (context: https://www.jhsph.edu/news/news-releases/2016/generic-biologic-drugs-appear-comparable-to-brand-name-counterparts.html https://www.jhsph.edu/news/news-releases/2016/generic-biolog...). Second, this is a case where Genentech (the maker of Avastin and Lucentis) is basically trying to prevent people from prescribing a cheaper drug that can be substituted. Genentech's made the argument that Lucentis is specifically designed for this use, while Avastin has issues (safety and efficacy). Doctors have some latitude to prescribe off-label drugs where there is an indication it's safe and effective. In this case, doctors are basically subdividing avastin packets (which has a risk). More reading: https://www.nih.gov/news-events/news-releases/avastin-lucentis-are-equivalent-treating-age-related-macular-degeneration https://www.nih.gov/news-events/news-releases/avastin-lucent... https://www.bmj.com/bmj/section-pdf/187523?path=/bmj/344/7855/Feature.full.pdf https://www.bmj.com/bmj/section-pdf/187523?path=/bmj/344/785...

by olvar_ 8y ago

makomk 8y ago

The cheaper alternative that the NHS wants to offer is not actually the same as the more expensive drug that's licensed to treat wet age-related macular degeneration. It's related and there's every reason to believe it's as safe and effective as the licensed drug, but it's still not the same stuff.

gerdesj 8y ago
The cheaper one is 3.5% and 5% the price of the other two and is recommended by WHO and used widely around the world, including the US. As always the decision as to what will be appropriate will lie with the doctor but at least they have the option now. I expect that the price of the other two will mysteriously drop quite dramatically now ...
- candiodari 8y ago
  Yes but there's 2 issues: 1) not in the same concentration/dose (patient will need to change the dose by breaking pills) 2) not according to the UK government (which has never approved the cheaper drug) So now the big question is, suppose this goes very wrong for a patient, who is responsible ? The doctor ? The patient ? The government ?
  - jaclaz 8y ago
    >1) not in the same concentration/dose (patient will need to change the dose by breaking pills) Specifically I don't think they are using pills (untouched or broken) to make intraocular injections.

dekhn 8y ago

this is a more complicated situation. First, for biologics, there are rarely equivalent generics (context: https://www.jhsph.edu/news/news-releases/2016/generic-biologic-drugs-appear-comparable-to-brand-name-counterparts.html https://www.jhsph.edu/news/news-releases/2016/generic-biolog...). Second, this is a case where Genentech (the maker of Avastin and Lucentis) is basically trying to prevent people from prescribing a cheaper drug that can be substituted. Genentech's made the argument that Lucentis is specifically designed for this use, while Avastin has issues (safety and efficacy). Doctors have some latitude to prescribe off-label drugs where there is an indication it's safe and effective. In this case, doctors are basically subdividing avastin packets (which has a risk). More reading: https://www.nih.gov/news-events/news-releases/avastin-lucentis-are-equivalent-treating-age-related-macular-degeneration https://www.nih.gov/news-events/news-releases/avastin-lucent... https://www.bmj.com/bmj/section-pdf/187523?path=/bmj/344/7855/Feature.full.pdf https://www.bmj.com/bmj/section-pdf/187523?path=/bmj/344/785...