GP Practise, changing prescription for cheaper one!!

[birdladyfromhomealone]

. Im spitting mad today.
I have had a letter from my GP telling me the practise can not afford to pay for my cancer drugs prescribed by my Neurologist so as of next week they are changing my prescription for a different type which is cheaper for the practise.
I pay for my prescriptions £30 plus a month.
Who do they think they are?

It has taken months to get used to these drugs and they want me to change and get more side effects to get used too 😞 I am seeing the neurologist team at Kings on Monday afternoon for my 6 month check up so will complain to them and see if they will write to my GP.

Swelling is going down on my tummy now and no more bleeding.

I am having a mammagraph next week then get all my results on Aug 22nd at the Oncology unit at Royal Marsden. I have felt so much better this week.

But why should my doctor change my drugs that were rescribed to me BY AN EXPERT!!!

People who notice differences between generic and branded medicines with exactly the same active ingredients (barring any allergies/intolerance to any inactive ingredients or reactions to differences in delivery method) are showing that they are affected by the placebo effect.
i.e. - idiots

It’s more complicated than that. The vast majority of generics are truly equivalent to the originator, but in some cases this is not so. There can be significant differences in bioavailability between branded and generic medicines, and between different generics, even though they appear to be the same formulation. In most instances there is no clinical effect, but in some there is.

People who buy Nurofen rather than Asda ibuprofen may have been duped by the branding, or may be experiencing the placebo effect. That doesn’t make them idiots.

As PP have said, if OP won’t tell us the medicine then no-one can tell her whether she is being unreasonable or not.

I complained about being switched to a different, cheaper maintenance asthma med. Same formulation and dosage (allegedly), different method of delivery, gave me issues with my asthma after having pretty much zero issues since changing to my current prescription over 10 years ago
Exactly the same thing happened to me, and this was in the UK. I was told it was exactly the same medication when I went back and told the GP it really wasn’t working. I pointed out the method of delivery was different and that was causing me problems and my asthma got steadily more and more out of control. I was referred to an asthma specialist, had more GP visits about it than I’d had since my diagnosis and finally after a bout of flu ended up in itc with pneumonia. After the week + I spent there the discharging consultant (who luckily happened to be a respiratory specialist) put me back on my original drugs and wrote in the GP copy that I was to be kept on them in future. No part of that saved the NHS money.

I work in pharmaceuticals. It may be that one is a brand and there is a generic (same but lower cost) available.

I'd speak to your specialist and get advise from them

It's hard to comment without more info - I have a GP (that I wish I could change but rural so no choice) who always knows better and doesn't need to listen to my consultant, nhs guidelines or even me when they decide on what to do. It usually takes a few goes to get things sorted.
Luckily for me I know my condition, my consultant and my specialist nurse well and have a Dr for a husband.
They have tried to change my drugs several times not for cheaper generics but other cheaper drugs that I have reacted badly to in the past and will not take or to withdraw drugs completely (dangerous) because 'they know better (than everyone else), they've been practicing a long time and money doesn't grow on trees'.
I have no doubt that if there wasn't a shortage of GPs this one would be out on their ear. My friend who is also a GP gets very frustrated when I tell her about them.
Thankfully my very expensive & very effective main medication is prescribed by the hospital directly and comes directly to my home via a specialist provider.

However I have no problem with generics instead of branded in cases where it's come out of licence and is the same thing made by someone else. Often it makes little sense not to change. Best value means that they can treat more people. However I suspect the process is often mismanaged and people are just told that they are not getting their drugs anymore making them panic rather than explaining the process and reasoning behind the decision.

I've no objection whatsoever to switching to generic versions of branded drugs. I don't care if the box my migraine tablets come in is labelled Imigran or sumatriptan, and any difference in efficacy is minimal.

I'm getting a bit pissed off with their efforts to change my hay fever (actually, multiple allergies and allergic rhinitis) meds for a cheaper one though. I've been prescribed acrivastine for about 20 years. Every now and then, a new one comes out and they get me to try it, that's fair enough. They never work as well as acrivastine, so I go back to it.

Lately, they've insisted on prescribing another anti-allergy "to try". Often, these are meds I've tried before and not stuck with them. They never work as well as acrivastine 3 x daily. Most of them seem to be one-a-day meds, which are especially shite, because my allergies are at their worst in the morning and evening, and whichever time of day I take them, they seem to lose their effectiveness within 24 hours.

About 20 years ago, I was referred to an immunologist who tried to get the the health authority (as it then was) to stump up £500 for a course of injections tailored for my specific allergens. These have a cumulative effect, and often desensitise patients to allergens for decades. They didn't want to know.

If I'd had the injections, I probably wouldn't need the bloody acrivastine and the savings would probably have covered the costs of the shots by now.

And then there's the sinus operation I might not have needed, had I not been permanently full of snot...

OP i'm sorry to hear about this but cancer drugs are extortionate in price. You say you are paying £30 a month, the drugs are more than likely costing the NHS a few hundred, if not thousand a month. There will be a budget that needs sticking to and your particular drugs are just costing too much. They will not swap to something less efficient, they aren't allowed to do that. The NHS isn't a never ending pit of money i'm afraid, although i can see why you'd find it so frustrating. On a different note, you should be getting prescriptions for free with a cancer diagnosis. Please look into this. If you don't qualify for some reason then you can still get a pre-payment certificate which will cut down your payments to just over £10 a month, and this will cover all the prescriptions you need.

Ok I'll just go away and die then, that will save the NHS ££££

So you still aren’t willing to say what you are taking - being ridiculous now OP

Nice flounce OP - why don't you just tell us the names of the drugs in question and you may well get an expert reply from a pharmacist who will be able to explain to you what the difference really is.

In your case I would certainly get in touch with the neurologist who prescribed these drugs. Perhaps they are just as good but you need to speak to the prescribing consultant.

@Cath2907 - They be a generic or a biosimilar. In either case the NHS guidance would be to use the cheaper version. These drugs are essentially the same as the brand name originator

That isn't entirely the case for biosimilars (I'm struggling with how to teach this to medical students at the moment). A biosimilar is usually a monoclonal antibody (mAb) against the same biological molecule as the proprietary biological therapy but the selection of the antibody - by phage display and in vitro or in vivo hybridoma culture - will lead to antibodies with different affinities, and possibly affinity for different epitopes. So, while you might produce a new mAb that targets CD20, say, in the same way as rituximab, you can't guarantee that you'll need exactly the same dose or that the effects will be exactly the same as for rituximab. This isn't much of an issue if you're starting a patient on the biosimilar, but it might be an issue if you wanted to switch a patient from rituximab to the biosimilar. It's not quite as straightforward as switching from branded to generic non-biological therapies. Given how many new biologics have become available for treatment of various forms of cancer in recent years, this is obviously a hugely important area.

pinksparky probably because more expensive ones were individual without preservatives - you are not suppose to use the one with preservatives for along period or more than 4 times a day - getting the right eye drops that don't worsen your eye condition is a bugbear! Actually the ones with preservatives can cause superior limbic keratitis which is long lasting & (quote from specialist) a miserable condition.

It isn't the GP that decides its the CCG / PCT, they will be advising the GP to switch the drugs or face penalties... this is what the NHS is now, your drugs will cost an awful lot more than the £30 you will be paying, I can see why you would be unhappy but I think still think that the NHS has to try and make ends meet and if a cheaper alternative can be found then why shouldn't it be used? In your situation I would give the alternatives a try as you may find that they are absolutely fine, then if not speak to the GP.

Unfortunately you won't know if you'll be fine on the generic ones until you try them.

Some people are sensitive to brand changes. With OTC drugs I do great on generics same for most prescriptions.

However for the main medication I take for my bipolar I only do well on one generic and the name brand, but that generic isn't available outside of the US. When they tried me on the generic here my mental state deteriorated within a week. So now my doctor writes it only for the name brand.

Before you do go away and die, please tell us the drugs that your GP wants to change! Then the pharmacology experts on here van give you an informed opinion on whether your GP is being unreasonable or not.

Lots of misinformation on this thread. I am a pharmacist and I work in a GPs surgery. It’s not clear from your post what drugs you are taking nor specifically what for. Neurologists don’t usually treat cancer this is normally treated by an oncologist and the prescriptions normally remain under the specialist oncologists rather than coming to the GP for prescribing so it sounds like this is an unusual situation.
It sounds likely that they have changed a branded medication for a generic one. For the vast majority of medications this is unlikely to cause any problems what so ever and most patients will get on just fine with the switch. It also saves our hard pressed NHS a lot of money. For a small number of medications including a number of drugs for epilepsy (which could be the case here) it is important not to change brands and your GP may not realise this.
Ultimately individual prescribers are responsible for the drugs they prescribe. GPs are not subservient to specialist consultants and there to do their bidding and if your specialist ultimately doesn’t agree with your GPs decision they should retain responsibility for prescribing your medication. The specialist can advise but they cannot ultimately force another prescriber to do something they aren’t happy to do.
Also GPs don’t pay for the medicines they prescribe the local CCG does.
And the £30 a month is irrelevant. This is a prescription tax that is very unlikely to cover anything like the full cost of the medication. It doesn’t give you a right to dictate what make of drug you can have unfortunately although I can understand why this is distressing when you have a serious medical condition.
If you have cancer you can also apply for a prescription exemption certificate.
Hope that helps and you can get it sorted soon.
If you’re not happy just ring your practice and ask them to explain what had happened.
If you give me the names of the drugs involved I may be able to advise further

What is the name of the medication OP , then we may be able to advise....flouncing off isn't helping your cause

Happened to me with the mini pill - on Cerazette happily for about 8 years, changed it to Cerelle. After 8 blissful period-free years I started to get breakthrough bleeding and put weight on that I just couldn’t shift. After about a year I discovered online ordering through Lloyd’s and did that (I would have been quite happy to pay the NHS but apparently this isn’t an option).

Also happened to my mum with her heart medication (one was Sotalol, can’t remember the name of the other one), she got terrible side effects and now has only branded versions.

As others have said, it is not necessarily the GP who has made this decision but the CCG who are responsible for costs. They will be pressuring the surgeries to go with the cheaper generics where possible. Their prescribing habits will be reviewed by the pharma team at the CCG.

Now, unfortunately some drugs do not work in quite the same way when a different coating is applied. I have a colleague who is a senior Nurse whose husband had a major fit because the generics did not work in the same way. She now has to watch carefully that a helpful pharmacist does not sub them.

Ok I'll just go away and die then, that will save the NHS ££££

This is quite an immature attitude. Obviously your health is your priority, but other people's health are their priority. Who's more important?

You underestimate how stretched the NHS is, it will not survive another generation in it's current structure. I have worked in it long enough to see how downhill it has gone and how the sheer number of patients are crippling it. It's not anyone's 'fault' and nobody is trying to take it out on you. You could always pay for private care if you feel as if the NHS is failing you. Although i imagine you will respond in a 'why should i?' manner.

The first thing to find out is if this change is to the same drug with a generic name. If so it should make no difference. If not you should talk to your consultant about the best drug. The drug companies make an obscene profit out of the NHS and if all drugs were generic instead of named brands, many more people would have access to drugs and treatment. Look in the supermarket at the differnce in price between Panandol and generic paracetamol. GP practices should be responsible with NHS money. If however the change might have implications for you then complain, you need to know more first though

More than likely the drug is pharmaceutically the same but is generic rather than branded. The difference is price is often astounding. Without knowing what drug it is it's impossible to say but many, many drugs are far more expensive than the cost of the prescription. For example previous endometriosis treatment I had cost the NHS £83 per injection. At the time I think prescription costs were about £5/6 as was a few years ago. Specialist drugs cost a fortune.

I have no problems using generics where possible but it depends on the medication.

My son has severe mental health difficulties and is balanced perfectly on the medication he is currently on. The tablets he is on are not generic, his psych refuses to prescribe generic and the pharmacist won't dispense generic. I know this because his usual manufacturer stopped making one of his tablets in a certain size, the chemist wouldn't prescribe the generic until he had spoken to the psych to make sure it wouldn't cause a problem. He couldn't get the psych so rang the GP who said to dispense two smaller ones of the same drug until it could be sorted (say 2 x 100mg instead of 1 x 200mg). Psych subsequently said to stay with this. Pharmacist told me that generics are not the same as branded for certain illnesses.

OP have you tried asking your pharmacist whether the generic would work?

If you are in drugs for cancer treatment you can get an exemption certificate. Your GP signs a form and you send it off. I have one for my tamoxifen and it lasts 5 years. Covers all prescriptions. You shouldnt have to pay