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Re: E-DRUG: Mandatory generic prescribing vs trade mark rights

Dear Colleagues,

A few more comments relating to Bada's message on 10/10/96.

In Australia we have had similar battles to South Africa to introduce mandatory
generic prescribing.  

In public hospitals it may differ a little from state to state but generally
hospital policy requests doctors to prescribe by generic name. This has
generally been accepted for a long time.

Outside of public hospitals, including in private hospitals and
community practice, there is the Pharmaceutical Benefits Scheme which
covers most prescribing. The Scheme includes a comprehensive list of
drugs for which the government subsidises patient dispensing costs.
Several years ago there was an attempt to introduce mandatory generic
prescribing for the Scheme. The drug companies responded aggressively
with all sorts of propaganda. In addition, doctors were not adequately
prepared to accept the concept of generic prescribing only.

After much negotiation between government, industry, academia and
consumers, the policy was modified. Generic prescribing is encouraged
but doctors are entitled to specify a brand name, particularly if the
patient requests a brand. There have been consumer education programs
to raise awareness, so the consumer will know that all drugs have to
comply to certain standards, and to know the right questions to ask
pharmacists and doctors.

Patient charges for Scheme items are based on whether the patient is a
pensioner or has a concession, not on the drug prescribed, except for
brand name products. The patient must pay a brand name premium if they
are dispensed a brand name product, if there is a cheaper generic
equivalent available on the list. This additional charge varies from a
few cents to a few dollars. If a drug is prescribed by brand name, the
pharmacist will dispense the brand name unless the patient requests
the generic name equivalent.

With some exceptions, doctors are not entitled to dispense in
Australia. Although this may serve professional interests, there is a
good reason for consumers to support this arrangement. It is quite
clear that prescribing is more appropriate and economic when the
prescriber does not have a financial interest in the prescription.

In ERITREA, mandatory generic prescribing has been introduced into
both the public and private sector and is being accompanied by an
enthusiastic education campaign, since some prescribers take a while
to lose old habits.

Jonathan Dartnell
Clinical Pharmacology & Therapeutics
The Royal Melbourne Hospital

Bev Snell
Australian Therapeutic Guidelines Program

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