Making medicines evergreen

BMJ 2012; 345 doi: (Published 29 November 2012) Cite this as: BMJ 2012;345:e7941

Re: Making medicines evergreen

Hitchings and colleagues' excellent analysis of the methods used by pharmaceutical companies to maximise profits omitted a recent example of a novel tactic which has resulted in additional annual costs to the NHS of £46 million.

The technique involves exploiting the fact that the price of generic medicines is not negotiated with the Department of Health, as market forces are intended to keep prices competitive. However, medical treatments do not always obey the usual rules of the market, and where there are significant clinical safety reasons for prescribing by brand, the generic market may not prevent excessive price rises.

In September 2012 Pfizer announced the sale of the marketing rights of the epilepsy drug Epanutin (phenytoin) to another company, Flynn-Pharma. The drug was still to be made by Pfizer and would be identical in all respects - even to the extent of having the name Epanutin stamped on the capsules. However, it would now be packaged under a different name, and, crucially, Flynn-Pharma were able to describe the product as generic. This meant that the previous price controls were lifted and the price could be increased more than 23-fold. The cost of 28 capsules rose from 66p to over £15.

The reality is that there is no generic market for phenytoin. Pfizer are the only company to make the capsules in the UK, and were another company to start to manufacture or import them, doctors would not be able to switch on cost grounds, as the recommendation is to prescribe by brand in order to reduce the risk of destabilising a patient's epilepsy. For a condition where the stakes are high - the consequences of a single seizure can lead to death or serious injury and the prohibition from driving for a year - this is a risk that no doctor should take.

The exploitation of this loophole has cost the NHS a significant amount of money in times when budgets are being reduced, caused considerable anxiety among epilepsy sufferers worried about changes to their medication, and has no clinical justification whatsoever. I have raised the issue in the media ( and with the Health Secretary. Disappointingly, the Department of Health is not inclined to investigate.

Competing interests: No competing interests

17 December 2012
Martin D Brunet
General Practitioner
Binscombe Medical Centre
106 Binscombe, Godalming, GU7 3PR