NHS Switching Guidelines

[CaveyUK]

This was posted on the Terrence Higgins forum, and thought I would share it here.

http://www.ukcab.net/wp-content/uploads/2017/04/Use-of-generic-medication-a-commissioning-perspective.pdf

It applies only to NHS England at the moment, which is under fairly extreme cost pressures, but could well be something seen in other countries who operate 'free at point of service' health systems should they also come under cost pressure.

Of specific note to myself, is that it is the NHS' intention to where possible, move people off Dolutegravir containing regimens (including Triumeq) to Raltegravir regimens. This is likely to only gain real traction when the once-a-day Raltegravir doses are released (2x600mg once), which this presentation indicates is likely to appear later this year.

My doctor mentioned this the other week to me. She said there may be justifications for not making these switches, but they will be under some pressure to do so - along with the well publicised switch to generics where available.

Probably only a few here who may be impacted further down the road, but worth sharing I think.

[Jim Allen]

Does not surprise me, or maybe it does surprises me they have not rolled further back.

Its only to save 21 million, its only about 329 million pounds short of what the exit did not bring as promised to the NHS  . But I suppose switching to generic drugs versions where possible makes sense and its an easy saving, every bit helps.

Not sure i would support dropping Dolutegravir arm as a treatment option for patients though.   

Jim

[CaveyUK]

I'm with you on that Jim.

I totally get switching to equivalent generics where available. That makes sense.

But Raltegravir isn't generic, and at least recently it was a similar price (to the NHS) as Dolutegravir, and more expensive than the single pill Triumeq. So it's a bit confusing, and makes me wonder if they have had some dispute over pricing with ViiV Healthcare.

Either way, I'm not crazy about changing myself...after all, I'm on something which works, and suits me. I know RTG is a good drug and the same class, but whats the point in risking there being some extra side effect I don't get with DTG or some strange resistance issue happening which wouldn't have if staying put.

Like I say, I 'get' reducing costs through generics, but this one seems a bit strange. I suppose it isn't likely to affect me till the end of the year at the earliest but it is concerning.

And yes, without paying billions for this ridiculous exit and without the re-election (with increased majority) of a government hellbent on taking us out of the EU regardless of if a deal is done or not, I'm not particularly optimistic about the future at the moment!