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Formularies not always the key to prescribing, says research

Pharma marketers need to go beyond formularies to understand NHS prescribing complexities, says Health Direction

Nearly one third of Primary Care Trusts (PCTs) in the UK do not have a drug formulary, according to new research from NHS information specialists Health Direction.

The revelation will make worrying reading for pharmaceutical marketers who see their sales reps' ability to convince PCTs that their drug should be placed on a PCT formulary as crucial in the changing NHS market place.

With decisions about which drugs can be prescribed gradually moving away from GPs, the industry's focus has shifted to organisations such as PCTs and the National Institute for Health and Clinical Excellence to promote recommended treatment procedures and drug regimes.

Health Direction say the findings of its 'Sophistication Index' database which uses live NHS data to measure the extent to which PCTs have made progress, are a warning that pharma marketers and healthcare development teams need to understand the complexities of prescribing in order to really make an impact.

ìDrug companies are completely passionate about the fact that there should be a formulary and their products should be on the formulary but quite often that's not really the be all and end all,î said Health Directions information director Sue Knox. ìIt's more about the cohesiveness of the medicines management support team and how well are they engaging with their practices. There are other considerations such as what the prescribing budget is like, whether a team is over- or under-spending, the size of the team accessing practices and the strength of a PCT's primary secondary care relationship.î

She added that some PCTs might announce that they do not have a drug formulary because they want GPs to prescribe products appropriately: ìIt's not so much about what drug they use but rather about using that drug with the right patients at the right time.î

The report warns that prescribing structures within the National Health Service may vary even more drastically than pharmaceutical marketers have previously thought. Data compiled from the 'Sophistication Index' showed that the ratios of generics to branded drugs prescribed by different PCTs fluctuated widely. In 32 per cent of PCTs, generics accounted for between 72 and 78 per cent of prescribed drugs while for 39 per cent of PCTs, this figure rose to between 79.5 per cent and 86 per cent.

Meanwhile the research found that only 8 per cent of PCTs had done 'extensive work' looking at prescribing of non-steroidal anti-inflammatory drugs (NSAIDS) and 37 per cent had done 'little work'.

ìLooking at NSAIDs, the PCT will want to see GPs prescribing the safest and most cost-effective versions of these types of drugs,î said Knox. ìHow that affects the resource devoted by a pharmaceutical company to this area could be quite significant.î

30th September 2008

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