Generic prescribing is not appropriate for inhaled drugs

The UK is experiencing an explosion of new drugs and inhaler devices being licensed for people with respiratory disease, increasing the complexity of prescribing for people with asthma or chronic obstructive pulmonary disease (COPD). The management of how these new products are introduced into clinical practice is important because they may vary in type of inhaler device and licensing.

One product is DuoRespSpiromax, a cheaper “branded generic” of Symbicort Turbohaler, both containing a combination of budesonide and formoterol. It should be noted that DuoRespSpiromax is not a “generic medicine” in the traditional sense of this term because the inhaler device, Spiromax, is markedly different to the Turbohaler, requiring different operations to prime and use these two devices.

Although generic prescribing is rightly being encouraged in primary care to reduce drug expenditure, this is not appropriate for inhaled drugs. Generic prescribing leaves the brand and inhaler device that may be dispensed open to interpretation by the pharmacist and may result in variability in the type of inhaler device the patient receives. This may have negative effects on patient adherence to the inhaled therapy and on the control of their disease.

Consequently we recommend caution before switching patients to the cheaper device as a generic substitution because studies have shown that switching inhaled corticosteroid devices without a consultation may be associated with worsened asthma control^[1]
. Pharmacists should ensure that they have systems in place to ensure that patients are issued the same inhaler device at each dispensing episode, no matter which pharmacy they take their prescription to.

The increasing range of inhaler devices presents an opportunity for pharmacists to optimise inhaler technique and recommend or prescribe a change in inhaler device as part of a concordant asthma or COPD review, or medicines use review, where inhaler technique is assessed and patient agreement is obtained. We would urge that this is the only appropriate time to change inhaler device, and not as part of a prescription switch policy.

Over the next few years, it is expected that a number of inhaled drugs will become available as generics, but likely in alternative inhaler devices to the branded equivalents. It is important that, if these are used, people are consulted before switching inhaler devices, and their inhaler technique assessed and optimised with the new device.

To ensure that every patient with asthma or COPD is issued with the same inhaler device at every dispensing episode, we recommend that inhaled medication should only be prescribed by the brand name.

Toby Capstick

Lead Respiratory Pharmacist

Leeds Teaching Hospitals NHS Trust

Toby.Capstick@nhs.net

Hasanin Khachi

Lead Pharmacist

Respiratory Medicine

Barts Health NHS Trust

Anna Murphy

Consultant Respiratory Pharmacist

University Hospitals of Leicester NHS Trust

Grainne d’Ancona

Principal pharmacist

Guys and St Thomas’ NHS Trust

Helen Meynell

Consultant Pharmacist

Doncaster Royal Infirmary

Patrick Wilson

Senior Respiratory Pharmacist

University Hospitals of Leicester NHS Trust

On behalf of the UK Clinical Pharmacy Association Respiratory Group

DECLARATION OF INTEREST:  Mr Capstick has received payment for educational events and conference sponsorship from Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Novartis, Pfizer and Teva. Hasanin Khachi has received payment for educational events and conference sponsorship from Almirall, AstraZeneca, Boehringer Ingelheim, GSK, Napp, Novartis and Teva. As part of the NHS Leadership Academy Top Leaders Programme, Khachi was seconded to GSK within the Government policy team during a one-year fellowship for two days a week. Anna Murphy has received payments for educational events and conference sponsorship from Almirall, AstraZeneca, Cheisi, GSK, Pfizer, Teva; and research funds from Almirall, GSK, Napp. Grainne d’Ancona has received payment for respiratory educational events and conference sponsorship from Almirall, Boehringer Ingelheim, GSK and Napp in the past five years. Helen Meynell as received payment for educational events from Almirall, AstraZeneca, Boehringer Ingelheim, GSK, McNeil, Napp and Novartis. Patrick Wilson has received payment for educational events from Chiesi, and research funds from Gilead.