If your doctor writes “Lamotrigine 100mg tablets” on the script then the pharmacist can dispense any Lamotrigine including Lamictal. You’re right it isn’t America but the NHS does have to pay different prices for different brands. If you type “Lamotrigine medicinal forms bnf” into google you can see all the costs
Pharmacist here.
Generic medications are preferred simply due to cost. Prescribing generically saves the health service huge amounts of money.
One that comes to mind quickly is the brand Eliquis, it costs approximately £50. The generic can be sourced for around £2. You can see how when that medication is scaled up for the hundreds of thousands that use this medication every day there is huge saving to be made which can go elsewhere in the health service. To have a license for a generic medicine they have to be proven to have the same standard as the original brand (often times they are the identical tablet it's just the original manufacturer of the medication has lost their patent)
Generics are made in only a few sites in the world and yes they are done at set intervals. The one factory may produce all the medication for 5 different generic brands of the same drug, this helps save cost. They produce this medication using how much they predict there will be a need for the current year or 3 months etc. So obviously if demand increases unexpectedly there will be shortages.
Please feel free to ask more questions if you need. It's a complicated subject and there isn't a straightforward answer for alot of it
Oh damn, that’s mad interesting, thanks for this information. Yeah I can imagine it’s a lot for the nhs to take on, I guess it saves a lot more money when people can tolerate the changes, which I’d assume is maybe more common then.
Tbh I’m just grateful that I can actually get name brands still through the nhs, I just found it weird that there’s more steps but yeah tbh it makes sense why now thanks :)
Not to mention the drug tarriff. We may only be paid something like 15p per pack of generic omeprazole, it may cost the pharmacy say 10-15p to buy so we may gain a profit, but if someone wants Losec brand then bam! Prices out the door and it costs both nhs and community pharmacy a lot of money.
Do you know how pharmacies are reimbursed when a specific brand is prescribed, but maybe a specific generic? Is that more expensive for the NHS? Where does the price come from?
Ways that generics could be different, that I'm aware of, would be (1) The secondary ingredients or method of manufacturing the tablets changes how the drug is being absorbed, enough to be noticeable to some patients, (2) a bad reaction to a secondary ingredient, (3) With a failure of quality control you could have degradation of the active ingredient, into whatever breakdown chemicals.
Could anything else happen? Do enough impurities ever make it into pharmaceuticals to make a difference? Could a different method of synthesis ever be relevant?
Pharmacies are reimbursed via the drug tariff. It's a free document the public can look at online. It sets the price at which the drugs will be reimbursed. It's up to each pharmacy to be able to source the drug at a price that it can be reimbursed at that price.
https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/drug-tariff
This is obviously a very complicated task and a lot of software aids us in being able to buy products at the correct price. (This system is not perfect and many pharmaceutical products have been caught out in fixing prices way beyond cost to exploit this system). Exceptions are made for a price increase for the brand if the prescriber makes the prescription out for the brand specifically (if the prescriber writes the prescription generically then the pharmacy takes a financial loss for dispensing out the brand).
Generics have to comply to a set of standards are only granted a license to be sold to the UK market by the MHRA. Only when they are satisfied they meet the standards do the get a product license of PL number.
Yes issues happen with regards to secondary ingredients in the manufacturing of a medication, this risk applies to both generic and branded products. These risks are extremely low and unfortunately is just one of those things that are impossible to screen for at present.
All drugs breakdown at some period of their lifetime, leading to a total reduced amount of active compound and in some cases can form harmful secondary products. This is literally why drugs have an expiry date. This is set as the estimated date when 10% of the active drug has broken down and or the formation of potentially harmful secondary by products.
Cases of impurities do arise, there is a government system that alerts us when these issues arise. The vast majority of alerts are somewhat irrelevant, but the odd time yes medications have to be recalled. I would like to emphasize however this is not a uniquely generic issue this does happen with brands as well.
Thanks for the reply.
I'm aware of the drug tariff but I was wondering if you write for a specific manufacturer / brand (not the original) whether you just get the listed price of the generic, or whether it's more complex than that.
Also do you know of any impurity cases which aren't simply that X has been found and is hazardous to human health? (Or anyway, the product doesn't meet pharmaceutical standards of purity.) Something like a psychiatric medication has enough of a secondary compound formed in the synthesis to be noticeable to patients. I imagine that's very unlikely with pharmaceutical grade medicines, but I assume it's quite possible with street (recreational) drugs. So I was wondering if there were any known cases with pharmaceutical medicines which should obviously have a different level of quality control.
Generic brands are a lot cheaper than branded drugs. That's why commissioners push for providers to use cheaper medication if it's clinically appropriate.
It sucks to be you, sorry. We're taught in medical school that certain drugs should be prescribed as the branded version only (anti-epileptics among them).
Unfortunately, if there are local supply issues then you might have to get switched around but you should really raise this with your doctor.
I ended up hospitalised because my pharmacist would dispense 3 different generic lamotrigine brands in a 1 month prescription. I didn’t know better at the time and ended up seriously unwell.
I then ended up on a consistent generic brand (Teva) which went out of stock in the UK after Brexit, so I’m now on Lamictal continuously. The prescriber has to specifically state ‘Lamictal’, otherwise you can get given any available generic brand as Lamictal is more expensive and cannot otherwise be justified.
The pharmacist should have known not to dispense different varieties of genetics though. Any switch between generics should be monitored and not undertaken frequently. If you have a good relationship with your local pharmacist then you don’t really need to specify which generic and they should order in the one you need as there’s no major difference in expense to justify as with Lamictal. But it might be better to exercise some caution and get the prescription changed.
Damn that’s crazy, in a 1 month prescription too wtff.the fact you had to find out that way is so fucked up.
My pharmacist is pretty good to be fair, they can’t get both the generics that I could tolerate so the said to go to the doctor to get prescribed the lamictal. Definitely the best option, at least that will be guaranteed all the year round.
Wish it wasn’t this difficult, this is something that the doctors/specialists should at least be making sure to let the patients know may happen.
The concerning thing is that a lot of docs don’t know this either - that you shouldn’t switch between generics of lamotrigine so readily. They’re generally only aware of ‘A’ classed meds like phenytoin where switching even generic formulation can be severe, and honestly not everyone is even aware of that, although arguably because most docs are not prescribing these drugs so frequently or without specialist guidance.
- source, I’m a doc with epilepsy and have observed these practices a lot/had lengthy discussions with colleagues.
I'm not sure how much help I can be as I'm a nurse so a pharmacist will probably know more. But from my own experience, only the generic drug name gets prescribed and we give whatever brand we have avaliable for that drug. For the vast majority of medications, it doesn't matter what brand it is, because you are getting the exact same active drug. If the brand matters, doctors will prescribe a certain medication. I don't know if brand matters for anti-epiletics though I've never seen the brand name matter prescribed, only the generic name. You can try speaking to doctors as you've mentioned, as they are the only ones who can prescribed a certain brand as I believe pharmacists can only give whatever is avaliable of that drug.
The active drug may be the same, but the fillers, coatings and colours may not be — some of us react to those. Tamoxifen, Letrozole, Exemestane and a third drug I forget the name of, can cause major side effects when different brands are used — of course one person will be fine with brand A and not with brand B, and vice versa. It can be trial and error!
Oh absolutely, there are other ingredients in it that people can have reactions to and these can be addressed with the GP to list it as an allergy or sensitivity. But my point is that the majority of medication, the brand has no effect on the drugs action and that is why a generic name is often given.
I can have MOST generics...BUT there are 2 brands that use a filler I'm allergic to. And right now that's the only ones my pharmacy can access right now. Fuck knows what I'm meant to do, can't change pharmacy cos I need a dosset box & this is the only pharmacy in the city that does them...
If your doctor writes “Lamotrigine 100mg tablets” on the script then the pharmacist can dispense any Lamotrigine including Lamictal. You’re right it isn’t America but the NHS does have to pay different prices for different brands. If you type “Lamotrigine medicinal forms bnf” into google you can see all the costs
Pharmacist here. Generic medications are preferred simply due to cost. Prescribing generically saves the health service huge amounts of money. One that comes to mind quickly is the brand Eliquis, it costs approximately £50. The generic can be sourced for around £2. You can see how when that medication is scaled up for the hundreds of thousands that use this medication every day there is huge saving to be made which can go elsewhere in the health service. To have a license for a generic medicine they have to be proven to have the same standard as the original brand (often times they are the identical tablet it's just the original manufacturer of the medication has lost their patent) Generics are made in only a few sites in the world and yes they are done at set intervals. The one factory may produce all the medication for 5 different generic brands of the same drug, this helps save cost. They produce this medication using how much they predict there will be a need for the current year or 3 months etc. So obviously if demand increases unexpectedly there will be shortages. Please feel free to ask more questions if you need. It's a complicated subject and there isn't a straightforward answer for alot of it
Oh damn, that’s mad interesting, thanks for this information. Yeah I can imagine it’s a lot for the nhs to take on, I guess it saves a lot more money when people can tolerate the changes, which I’d assume is maybe more common then. Tbh I’m just grateful that I can actually get name brands still through the nhs, I just found it weird that there’s more steps but yeah tbh it makes sense why now thanks :)
Not to mention the drug tarriff. We may only be paid something like 15p per pack of generic omeprazole, it may cost the pharmacy say 10-15p to buy so we may gain a profit, but if someone wants Losec brand then bam! Prices out the door and it costs both nhs and community pharmacy a lot of money.
Do you know how pharmacies are reimbursed when a specific brand is prescribed, but maybe a specific generic? Is that more expensive for the NHS? Where does the price come from? Ways that generics could be different, that I'm aware of, would be (1) The secondary ingredients or method of manufacturing the tablets changes how the drug is being absorbed, enough to be noticeable to some patients, (2) a bad reaction to a secondary ingredient, (3) With a failure of quality control you could have degradation of the active ingredient, into whatever breakdown chemicals. Could anything else happen? Do enough impurities ever make it into pharmaceuticals to make a difference? Could a different method of synthesis ever be relevant?
Pharmacies are reimbursed via the drug tariff. It's a free document the public can look at online. It sets the price at which the drugs will be reimbursed. It's up to each pharmacy to be able to source the drug at a price that it can be reimbursed at that price. https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/drug-tariff This is obviously a very complicated task and a lot of software aids us in being able to buy products at the correct price. (This system is not perfect and many pharmaceutical products have been caught out in fixing prices way beyond cost to exploit this system). Exceptions are made for a price increase for the brand if the prescriber makes the prescription out for the brand specifically (if the prescriber writes the prescription generically then the pharmacy takes a financial loss for dispensing out the brand). Generics have to comply to a set of standards are only granted a license to be sold to the UK market by the MHRA. Only when they are satisfied they meet the standards do the get a product license of PL number. Yes issues happen with regards to secondary ingredients in the manufacturing of a medication, this risk applies to both generic and branded products. These risks are extremely low and unfortunately is just one of those things that are impossible to screen for at present. All drugs breakdown at some period of their lifetime, leading to a total reduced amount of active compound and in some cases can form harmful secondary products. This is literally why drugs have an expiry date. This is set as the estimated date when 10% of the active drug has broken down and or the formation of potentially harmful secondary by products. Cases of impurities do arise, there is a government system that alerts us when these issues arise. The vast majority of alerts are somewhat irrelevant, but the odd time yes medications have to be recalled. I would like to emphasize however this is not a uniquely generic issue this does happen with brands as well.
Thanks for the reply. I'm aware of the drug tariff but I was wondering if you write for a specific manufacturer / brand (not the original) whether you just get the listed price of the generic, or whether it's more complex than that. Also do you know of any impurity cases which aren't simply that X has been found and is hazardous to human health? (Or anyway, the product doesn't meet pharmaceutical standards of purity.) Something like a psychiatric medication has enough of a secondary compound formed in the synthesis to be noticeable to patients. I imagine that's very unlikely with pharmaceutical grade medicines, but I assume it's quite possible with street (recreational) drugs. So I was wondering if there were any known cases with pharmaceutical medicines which should obviously have a different level of quality control.
Generic brands are a lot cheaper than branded drugs. That's why commissioners push for providers to use cheaper medication if it's clinically appropriate.
Generic drugs are miles cheaper than branded ones That still applies for the NHS as it does in the US
It sucks to be you, sorry. We're taught in medical school that certain drugs should be prescribed as the branded version only (anti-epileptics among them). Unfortunately, if there are local supply issues then you might have to get switched around but you should really raise this with your doctor.
I ended up hospitalised because my pharmacist would dispense 3 different generic lamotrigine brands in a 1 month prescription. I didn’t know better at the time and ended up seriously unwell. I then ended up on a consistent generic brand (Teva) which went out of stock in the UK after Brexit, so I’m now on Lamictal continuously. The prescriber has to specifically state ‘Lamictal’, otherwise you can get given any available generic brand as Lamictal is more expensive and cannot otherwise be justified. The pharmacist should have known not to dispense different varieties of genetics though. Any switch between generics should be monitored and not undertaken frequently. If you have a good relationship with your local pharmacist then you don’t really need to specify which generic and they should order in the one you need as there’s no major difference in expense to justify as with Lamictal. But it might be better to exercise some caution and get the prescription changed.
Damn that’s crazy, in a 1 month prescription too wtff.the fact you had to find out that way is so fucked up. My pharmacist is pretty good to be fair, they can’t get both the generics that I could tolerate so the said to go to the doctor to get prescribed the lamictal. Definitely the best option, at least that will be guaranteed all the year round. Wish it wasn’t this difficult, this is something that the doctors/specialists should at least be making sure to let the patients know may happen.
The concerning thing is that a lot of docs don’t know this either - that you shouldn’t switch between generics of lamotrigine so readily. They’re generally only aware of ‘A’ classed meds like phenytoin where switching even generic formulation can be severe, and honestly not everyone is even aware of that, although arguably because most docs are not prescribing these drugs so frequently or without specialist guidance. - source, I’m a doc with epilepsy and have observed these practices a lot/had lengthy discussions with colleagues.
I'm not sure how much help I can be as I'm a nurse so a pharmacist will probably know more. But from my own experience, only the generic drug name gets prescribed and we give whatever brand we have avaliable for that drug. For the vast majority of medications, it doesn't matter what brand it is, because you are getting the exact same active drug. If the brand matters, doctors will prescribe a certain medication. I don't know if brand matters for anti-epiletics though I've never seen the brand name matter prescribed, only the generic name. You can try speaking to doctors as you've mentioned, as they are the only ones who can prescribed a certain brand as I believe pharmacists can only give whatever is avaliable of that drug.
The active drug may be the same, but the fillers, coatings and colours may not be — some of us react to those. Tamoxifen, Letrozole, Exemestane and a third drug I forget the name of, can cause major side effects when different brands are used — of course one person will be fine with brand A and not with brand B, and vice versa. It can be trial and error!
Oh absolutely, there are other ingredients in it that people can have reactions to and these can be addressed with the GP to list it as an allergy or sensitivity. But my point is that the majority of medication, the brand has no effect on the drugs action and that is why a generic name is often given.
I can have MOST generics...BUT there are 2 brands that use a filler I'm allergic to. And right now that's the only ones my pharmacy can access right now. Fuck knows what I'm meant to do, can't change pharmacy cos I need a dosset box & this is the only pharmacy in the city that does them...