Branded, generics or branded generics? Do you know the difference?

When a branded, or proprietary, drug comes ‘off patent’ it is common for other companies to apply for marketing authorisation and we are, increasingly, seeing this in sexual health. This can be for generic versions or for branded generics. Branded generics are simply generic equivalent drugs with a brand name given by the particular company. When a pharmacist dispenses a proprietary drug or branded generic they are obliged to dispense the named product, if a pure generic is prescribed they can give any product containing the generic compound/s but this is reimbursed at the current generic rate.

To give an example in contraception Microgynon 30 & Ovranette are proprietary brands and Levest & Rigevidon are branded generic equivalents.

MeReC bulletin summarises:

• Generic medicines are, overall, much less expensive to the NHS. Their appropriate use instead of branded medicines delivers considerable cost savings. In England about 5% of medicines are still prescribed by their brand name when generic equivalents are available.
• List prices for some ‘branded generics’ may be lower than the reimbursement price for equivalent generics. However, any cost savings achieved by their use may be unsustainable by the manufacturer and may not necessarily be cheaper, or in the best interests of the NHS overall.

This may be because many companies marketing branded generics negotiate a fixed price for a fixed period for their products with pharmacies or clinics which are lower than, even, generic alternatives – however generic drug prices are subject to fluctuation due to market forces and may fall over time meaning this would no longer be the case.

The MeReC bulletin also signposts the UK Medicines Information (UKMi) Q & A document “Which medicines are not suitable for generic prescribing in primary care?” This lists medicines that may be considered suitable to prescribe by specific manufacturer’s product (branded or generic). These include:

– multiple ingredient products
– ensuring adherence to long-term medications, where differences in appearance between manufacturer’s products might cause confusion and anxiety

In contraception, over the years, we have probably not noticed when this has happened and the first of the reasons above, as well as the fact that there were not many generic versions available, may explain this. The second may be more pertinent in the future.

There are a number of reasons why these issues are currently topical in sexual health:

• cost saving – not only perceived savings on generics vs brands but increased bulk/group purchasing to afford greater savings within Trusts
• more companies are making and marketing branded generics than in the past
• more medicines used in sexual health are due to come off patent now or in the next year including: sildenafil, many HIV drugs, desogestrel and mifepristone
• increased use of paperless IT systems with built-in drug data bases, as in general practice, where generic equivalents are often highlighted
• different ordering capabilities of independent pharmacies vs large national companies/chains

There are potentially more likely to be problems with contraceptive pills prescribed in general practice than in clinics as clinics generally see women at each visit and can explain any differences there may be in dispensed products. A woman taking an FP10 to a pharmacy (if it is prescribed generically) may be given a different product from previously without the prescriber being aware that this could occur. And this may happen even if she goes to the same pharmacy as last time. Clinicians will be aware of the issues that arise if women are given different pills and the anxiety this may cause followed by increased clinician time required for extra appointments to handle any problems. This is always assuming the woman doesn’t just stop her pills if she is unable to access help in a timely fashion. Food for thought.

ella-One® black triangle removed

The MHRA has removed the black triangle from ella-One®. The black triangle will be removed from all company materials over the next few months and EC providers may need to update some documentation.