Letters Making medicines evergreen

Another loophole exploited by the drug industry

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f354 (Published 22 January 2013) Cite this as: BMJ 2013;346:f354
  1. Martin D Brunet, general practitioner1
  1. 1Binscombe Medical Centre, Godalming GU7 3PR, UK
  1. martin{at}binscombe.net

Hitchings and colleagues’ excellent analysis of the methods used by drug companies to maximise profits omitted a new tactic that has resulted in £46m (€55.5m; $74m) additional annual costs to the NHS.1 It exploits the fact that the price of generic drugs is not negotiated with the Department of Health because market forces are meant to keep prices competitive, but this is not always the case. If there are safety reasons for prescribing by brand, excessive price rises may occur.

In September 2012 Pfizer sold the marketing rights of the epilepsy drug Epanutin (phenytoin) to Flynn Pharma. The drug would still be made by Pfizer, would be identical in all respects (even having Epanutin stamped on the capsules), but would be packaged under a different name so that Flynn Pharma could describe it as generic. Previous price controls were lifted and the price increased more than 23-fold—from 66p to over £15 for 28 capsules.

But there is no generic market for phenytoin. Pfizer is the only company to make it in the UK, and if another company started to manufacture or import it, doctors would not be able to switch on cost grounds, because of the risk of destabilising a patient’s epilepsy. When a single seizure can lead to death or serious injury and a one year ban on driving, this is a risk that no doctor should take.

The exploitation of this loophole has cost the NHS a serious amount of money when budgets are being reduced, has caused anxiety in people with epilepsy, and has no clinical justification whatsoever. I have raised the matter in the media and with the health secretary.2 Disappointingly, the Department of Health is not inclined to investigate.


Cite this as: BMJ 2013;346:f354


  • Competing interests: None declared.