Changes to prescribing behaviour or NHS policy?

 

Firstly, a quiz for pharmacists working in community pharmacy.

 

How many prescriptions have you dispensed for the following items over the last year?

 

Dichlorobenzyl alcohol 1.2mg / Amylmetacresol 600microgram lozenges x 24

 

Hexylresorcinol 2.4mg lozenges x 24

 

Zinc undecenoate 20% / Undecenoic acid 5% cream 25g

 

Chlorhexidine hydrochloride 0.5% cream 30g

 

Guaifenesin 100mg/5ml oral solution sugar free 100ml

 

Guaifenesin 100mg/5ml oral solution sugar free 250ml

 

And the following question, without looking on your PMR system or the BNF or any other source, would you know what to dispense to the patient? {Hint, nearly all of these will be held in stock by most pharmacies]

 

Maybe I am being a little bit unfair, but these are not exactly generic names which are in common parlance in pharmacy.

 

Without giving away the answers [scroll down if you want to know straight away] these are all items which are usually sold to the patient as Over the Counter medicines.

 

So, what is happening here?

 

The above products are all being added to Part VIIIA of the Drug Tariff for England and Wales, some were added for the February Drug Tariff and some will be added to the March 2021 Drug Tariff, meaning they can be prescribed generically, and the reimbursement price is based on a specific brand.

 

In the past, most of the above products would be purchased by a patient in response to either a query to the pharmacist or perhaps even due to the advertising of such products in the pharmacy. The pharmacy when dispensing the items above will now get the reimbursement price and a dispensing fee.

 

Will this represent a loss of income to a retail pharmacy?

 

Is this part of a wider movement to increase the number of OTC or self-care products available via prescription?

 

Or is it a direct response to the impact of Covid-19?

 

Either way, how many GPs will consider prescribing any of the above items to their patients? My guess is most GPs won’t have any idea what brands these generic descriptions refer to. And I am also guessing that there are many GPs who might not see or know of any clinical benefit to some of these products.

 

Time to reveal the answers for those who can’t wait any longer:

 

Dichlorobenzyl alcohol 1.2mg / Amylmetacresol 600microgram lozenges x 24 [Strepsils Honey and Lemon]

 

Hexylresorcinol 2.4mg lozenges x 24 [Strepsils Extra Triple Action]

 

Zinc undecenoate 20% / Undecenoic acid 5% cream 25g [Mycota Cream]

 

Chlorhexidine hydrochloride 0.5% cream 30g [Germolene Wound Care]

 

Guaifenesin 100mg/5ml oral solution sugar free 100ml [Robitussin Chesty Cough]

 

Guaifenesin 100mg/5ml oral solution sugar free 250ml [Robitussin Chesty Cough]

 

According to English Prescription Cost Analysis for 2019 the prescribing associated with “Guaifenesin” amounted to a massive c£8,800 in dispensing costs to the NHS. With the clear market leader being prescribed by brand Robitussin Chesty Cough 100mg/5ml oral solution with a total of 764 dispensed items at a cost to the NHS of £3,841.84 at an average cost of £5.03 per item.

 

So why the need now to make it easier to prescribe generically?

 

This article was written by Greg Bull founder of the Dispensing Doctor Experts. You can contact Greg by clicking here.

 

 

 

Published by

PIP editor

A pharmacist led training provider.

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