Making medicines evergreen

Over the next three years, the pharmaceutical industry is projected to lose about £5.4bn in UK revenue as exclusivity rights on major brands expire.1 To prevent or mitigate losses from sales of cheaper generic versions, drug companies use a range of “evergreening” strategies to maintain market share. Many of these involve minor modification or reformulation of drugs that do not necessarily provide additional benefit for patients. In 2011, the National Health Service spent £13.6bn (€17bn; $21bn) on medicines, of which about £10bn was spent on branded or proprietary products.1 In an assessment of drugs that accounted for about a fifth of the primary care prescribing budget, the National Audit Office identified over £200m of unnecessary spending on branded products.2 Greater awareness of evergreening techniques could save money and avoid exposing patients unnecessarily to new drugs, with their inherently uncertain risk-benefit profiles.