Should pharmacists be allowed to substitute generics for prescribed brands?

Unless and until generic manufacturers improve the quality of their packaging;ie making pack design distinct for different stregnths of medicine then opportunity of confusion for the patient will remain, not to say picking errors in the pharmacy. Leave the situation as it is. regards BobDunkley

the budgets in health care are not infinate. by allowong substitution money can be saved and used for newer drugs that have no generic. This would allow PCT's to sanction newer drug use (they would have more money) and bring the NHS up to date. perhaps dispense has in the US. offer the patient the branded or the generic at all dispensing times. if they want the generic they get it via the NHS "free". if they insist on the branded they must pay the difference in price, with no exceptions. e.g. simvastatin at £1 per pack (free if they will have it) or zocor at £20 per pack the must pay, at the time of dispensing £19. with no exceptions. this could be irrespective of what is on the RX. it allows patients to excercise their choice it is not a tax on the poor or ill. also as in the US nearly all go with the generic "free" drug. funny that, but of course because the NHS is free at the source to most, patients put no value on what they are getting and take them anyway. just look at any pharmacy "to be collected" shelves and the dates on the RX's. they are usually old (>1 month) and not collected. the patients have not forgotton, they did'ent need them or were not taking them (MUR time)and have wasted the Dr time, the pharmacy time and the cost of the drug. but to a patient that does not matter, it's free and they can always order more for free when they really need them. I would bet that the US system means that there is no stock piling and that patients only get thier meds when they need them and has cheap as possible i.e. stuff the branded. why pay $19 for something that is $1 and even this $1 can be claimed on their health insurance-so it's free. take the branded and thier health insurance will refund them $1 and the patient is out $19. hence the reason they nearly always take the generic. a goog system for the UK providing the money saved is put back into the drug budget global sum and not used for other reasons. jb

Patients should have the option to pay extra for a branded drug, or particular generic brand, if they so wish. Similarly, I, as a pharmacist should have the option to over-ride the prescriber's choice of brand, with the patient's agreement, if it allows a more rapid supply, as happens with some dispensing practices who appear to have formulary policies to prescribe certain branded drugs (especially those which are priced at or under Drug tariff prices) rather than the generic equivalent.

I consider that the issue is not as simple as it appears. Some drugs need to be prescribed by brand because of differences in bio-availability etc having an effect on efficacy and these need to be excluded. Substitution of the majority of products would not be problematic but community pharmacies may use financial considerations to decide whether a brand or a generic is used. Because patients don't always recognise that a branded product is equivalent to a product with a generic name this could lead to confusion of identity. Hospitals switch scripts to the product they have in the formulary (often a brand and not a generic!) but with this they have agreement with a discrete cohort of prescribers. I think that it needs to be fully thought through before any consideration of implementation.