Branded vs. generic prescription

In Norway today almost all medicines are prescribed after the brand name, not the active substance, ergo by branded prescription. The Norwegian Medicine Agency (NOMA) has on an assignment from the Ministry of Health and Care Services (MHC) recently considered a transition from branded prescribing to prescribing by the active substance, – so called generic prescribing.

NOMA delivered its report in December 2016. In the report NOMA recommends a transition and emphasize that it is practical that medicine are prescribed after the active substance as this would contribute to more secure communication between health care professionals and between health care professionals and patients.

Current regulations open for a generic prescription, but the opportunity is rarely used.  In the pharmacies the patients are therefore often offered another brand than the one indicated on the prescription.  NOMA believes that this creates uncertainty amongst patients and larger risk of errors.  The arrangement also adds to the obligations of the pharmacy staff.  This could be avoided if the doctor only indicates the applicable active substance on the prescription. The active substance will also be known across national borders. Accordingly, NOMA’s recommendation for a transmission is first and foremost motivated by the consideration of patient security.  No economical profit of significance is expected as today’s in-pharmacy-swap-arrangement in fact already directs for the most reasonable medicine to be handed out.  However, NOMA emphasize that a transmission also will, in addition to making it easier for doctors to prescribe (they will not have to remember product names and prescriptions can be renewed without change even if unit packs are deregistered), lessen the pharmaceutical industry’s prospect to influence doctors prescriptions. NOMA assumes that today’s brand name advertisement will give less effect.

NOMA realises that mandatory generic prescription cannot apply in all events.  A two-track system is necessary to handle situations where medical or technical reasons require branded prescriptions or if the doctor has reserved against an in pharmacy-switch.  NOMA therefore suggests a so called “exemption list” is to be established.

The MHC has taken the matter up for further evaluation.  What is clear is that a potential transmission to mandatory generic prescription would necessitate considerable changes of today’s practice, the doctors’ journal systems, as well as the legal framework.  The MHC has been reluctant to provide information on if, when and in what way a transmission can be expected.  The MHC has however referred to NOMA’s report in which a 5 year step by step transmission is suggested.

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