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03 May 2017

BY AMA VICE PRESIDENT DR TONY BARTONE

As a working GP, I’ve seen the impact that medication misadventures can bring. It is  especially frustrating and upsetting  when patients, unfamiliar with a generic medication dispensed to them have accidentally become confused – believing it was medication for something else because it was a different colour or shape – and taken it together with their regular brand name drug. As a result double dose is taken, which depending on the medication, can be disastrous.

It was in this light that I recently commented on speculation regarding a policy change on generics and biosimilars.

The AMA is a strong supporter of using generic medications, when it is safe and appropriate and discussed with the patient. This is clearly outlined in our Medicines Position Statement (2014), which can be found here: https://ama.com.au/position-statement/medicines-2014

As stewards of the health system, we’ve advocated strongly for the effective and efficient use of health funds, with a strong view that savings should be reinvested in the health system. It’s why we’ve supported the vision of the MBS Review, it’s why we’re at the table as part of the current Private Health Ministerial Advisory Committee and it’s why we’ve advocated tirelessly for the lifting of the Medicare Freeze. We need a sustainable health system, supported by responsible behaviour by all medical practitioners.

When it comes to generics, the story is no different. It’s pleasing that Australian university training courses encourage trainee doctors to use the generic name of a medicine, and that Australian studies examining pharmacist dispensing behaviour consistently indicate that only 3% or fewer doctors marked the prescription ‘do not substitute’.

But the ongoing drive for cost savings can never come at the expense of patient safety and doctor autonomy. Recently there was high level reporting that a change was going to be made to generic and biosimilar policy. That reporting included speculation that there would be mandatory prescribing included as part of the change – potentially even of biosimilars, which as you know are not identical to the originator.

It was in this vein, and against these issues, which I spoke out. These mooted changes and the questions we fielded were disturbing news, to say the least. Furthermore, and perhaps most disappointedly; there had been no consultation with the AMA on such a potentially dramatic prescribing policy shift. And, as these changes related to speculation of potential budget measures, there was understandably no formal announcement and detail from Government on exactly what the changes were.

As doctors, our first, most critical thought is for the welfare of our patients. And some – especially those with multiple medications, the elderly, those who might have cognitive or vision impairment - rely on the look and feel of their medications in managing their daily doses.

So the AMA spoke out to make clear that mandatory prescribing – be it of biosimilars or generics –or any other radical changes would be very problematic. It could in some instances lead to medical misadventure and adverse events resulting in hospital admissions which could significant impact on health system costs, rather than save funds as intended. Some generics can have filler ingredients that may be contraindicated for patients, and there are variations inherent in biosimilars which also need to be accounted for.

Our point was that any Government measures to increase the take-up of generics or biosimilars needs​ to include protocols to support the use of originator medicines where the generic/biosimilar alternatives are contraindicated or fail to provide the desired therapeutic outcome. And of course, any new arrangement where software changes are made cannot add to the burden and time it takes for a doctor – every extra minute navigating software is one less minute talking with the patient.

To be clear, the AMA’s concerns were about the exceptions, when a doctor may determine that a brand medicine may be best for the patient, and not the general rule, which is about supporting generics and the efficient use of health funding.

I am pleased that as a result of the AMA’s comments around the importance of being able to prescribe the right medication for a particular patient, we have received confirmation that these changes will not result in mandatory prescribing, while still encouraging the greater uptake of generics where appropriate. We are told the changes in software to default to generics will not be time consuming either.

As you would have seen in media reporting, there may be substantial savings from the increased use of generics in appropriate circumstances, and the AMA therefore strongly supports these savings being invested back into the PBS, and the health system more broadly, to ensure that much needed medications and services are made available to the Australian public.

While the remaining detail will not be released until Budget night, these changes would appear to be in line with the AMA’s existing medicines policy. I am therefore hopeful we can have confidence, based on these reassurances received, that when our patients go to the pharmacy in the future, they get just what the doctor ordered.

 


Published: 03 May 2017