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Xrayser: Saving money with branded generics is delusional

"Branded generics – double-speak, straight out of 1984"

Xrayser struggles to explain to a patient the logic behind CCG's dispensing decisions

"Mr Smith, I'm afraid we don't have this in stock."

It's never pleasant having to tell a patient that you can't dispense his prescription, especially when the drug in question is a neuroleptic.

Mr Smith looked quizzically at me, and then gave me a fixed stare – the sort of look you don't want from someone on an antipsychotic.

"You haven't got any quetiapine?" he asked. "Yes," I replied. "I have got quetiapine, but just not the brand that your doctor has prescribed." And this is the point from which readers who work in community pharmacy will definitely recognise.

"You didn't have any last month," Mr Smith stated, quite correctly. I nodded, smiled, and said: "You're right, and we ordered extra so we could fulfill your next prescription. But this month your doctor has prescribed a branded-generic called 'Kwixotipine XL'.

"This is now the cheapest branded generic. So when he ordered your repeat script, his prescribing software will have popped up with a message from the clinical commissioning group's (CCG) medicines management person, saying 'Prescribe this as Kwixotipine XL and you can save a shed-load of money!' So that's what he's done."

“So you're giving me something different?” asked Mr Smith. I sighed.

“It’s like this," I started. "We make a small loss dispensing branded drugs, but a profit on generic drugs. So overall, patients get their drugs, we make an agreed profit, and I get to keep Mrs Xrayser in new clothes and prosecco – so everyone's happy.

“But then some twisted bastard came up with the idea of branded generics – a fine bit of double-speak, straight out of 1984 if you ask me.

"The makers of Kwixotipine XL give it a list price below the drug tariff generic price, so the CCG wins because it costs less and the manufacturer wins because they sell more.

“However, I don't get any discount on Kwixotipine XL. So after the discount clawback I make a loss, and Mrs Xrayser wears last years' clothes and drowns her sorrows with supermarket value cider.

“Also, branded generics are hard to order because they’re often either a special order, not listed by the wholesaler as generic, or out of stock," I told the patient. "Your last branded-generic has been out of stock for months, so we had to get your script changed. But every repeat was amended by the GP software back to the out-of-stock brand, until finally, the company admitted that their brand was being discontinued. So now the CCG has chosen Kwixotipine.”

Another question: "So he's not prescribed me quetiapine?"

"Yes he has prescribed quetiapine, but not as quetiapine. He's prescribed your quetiapine as Kwixotipine XL. I've got generic quetiapine, and I have other branded-generic quetiapine. But I don't have Kwixotipine-brand quetiapine. So I can't dispense this!"

Mr Smith stared at me for a moment, leaned forward and whispered: "Have you heard what you just said? I thought I was the one who was delusional."


Joan Richardson, Locum pharmacist

This whole situation is causing major problems as regards shelf space.  I've lost track of the number of split packs of different names of quetiapine and I've now seen  a branded generic metformin MR.  Also our stock holding goes through the roof as we have more and more money tied up in the "same but different" drugs.

The lunatics are truly taking over the asylum!

Matthew Edwards, Community pharmacist

Educate your CCG pharmacists.  I have explained on several occasions that if it is generically listed in the drug tarriff then it should be prescribed as such.  Once the point is explained and pharmacy funding is explained to these people then i have found that the surgeries will switch back to prescribing generically.

Leon The Apothecary, Student

CCGs always struggle with prescribing. Simple fix. Prescribe. Generically. Thin the BNF out and save a ton of money.

Valentine Trodd, Community pharmacist

Add this to the fact I'll soon need a bigger CD cabinet to house all my split packs if they come out with anymore branded generics of oxycodone!

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

And don't get me started on desogestrel brands.....

Valentine Trodd, Community pharmacist

Any idea when Zomorph goes off patent? More fun there...

Andrew Heed, Community pharmacist

Add in to this porridge the concept of biosimilars e.g. Rituximaybe, or as I like to describe them the entirely identical but fundamentally different equivalent of a non-static chemical entity.

Yes we are changing you to a different version of what you had last month it is identical in all respects apart from the differences, do not be alarmed though because we are confident that it is similar, not similar enough to be identical but similar enough to be almost certainly the same apart from the exceptions to this rule.

Olukunmi Popoola, Community pharmacist

Excellent post. 


Mahesh Sodha, Superintendent Pharmacist

Ad to this fact that the CCG Pharmacsits actualy get a "rebate" (bribe?) to get their GPS to prescribe Kwixotipine XL. Needd a thorough investigation!!

Really? Wow, Superintendent Pharmacist

Also need to mention that the GP's actually get paid to prescribe these items. I have seen documents where the CCG pays the GP 50% of the 'savings' that are made. 

The existence of these branded generics makes a complete fool of the internally corrected system of the drug tariff and should be banned. 

Snake Plissken, Student

That's interesting! What rebate/bribe might that be?

Kwixotipine XL case sounds a lot like

C+D Xrayser, Community pharmacist

You might think that - I couldn't possibly comment...

Mark Ashmore, Superintendent Pharmacist

Look up some FoI requests and CCG accounts and you will see some details of the backhanders they are getting at Pharmacy's expense

Chandra Nathwani, Community pharmacist

.....and then the cat m purchase margin is NOT delivered and another drug price is increased to delivery agreed margin. Then another switch is made to a branded generic and ......merry-go-around. Time to ditch this merry go around cat m "delusional" saving! Is it designed to keep someone in a job? It has taken years to get GP's to prescribe generically so the NHS can save money through competition of the generic molecule. But now that advantage for the NHS is being slowly destroyed. The problem is when another cheaper Quetiapine XL appears on the market, the GP repeat system continues to prescribe the original " cheaper" version until someone decides to "review" prescribing AGAIN. And WHt is the cost of this effort?


Ben Merriman, Community pharmacist

Of course, if it's prescribed as a branded medicine and not available from mainline wholesalers, it can be sourced as a special obtain with out of pocket expenses (which I have had to do a couple of times before) completely negating any savings.  But let's not confuse the situation with facts...

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