Prescribing by generic or brand name in primary care

Karoline Brennan, Senior Medicines Information Pharmacist, North West Medicines Information CentrePublished

Prescribing medicines by generic name is generally preferred but there are some circumstances when brand-name prescribing is warranted.

Definitions

Generic prescribing

Generic prescribing uses the recommended International Non-proprietary Name (rINN).

Brand prescribing

Brand prescribing uses the branded (proprietary) or branded generic name.

Benefits of generic prescribing

Generic prescribing is generally preferred. This is because it:

Reduces risk

Each drug has only one generic name, but may have many brand names; generic prescribing can reduce prescribing and dispensing errors.

Enables quicker medicine supply

If a medicine is prescribed by generic name, the pharmacist may dispense any suitable generic or branded product, which can reduce delays in supplying medicines to the patient. In primary care, if a medicine is prescribed by brand name, the pharmacist may dispense only the specified brand, unless a Serious Shortage Protocol (SSP) is in place.

Offers value for money

It is usually more cost-effective to prescribe generically as the pharmacy is reimbursed at a set price, listed in the Drug Tariff.

Increasing the level of generic prescribing in the UK has long been encouraged. The ‘potential generic savings’ dashboard highlights variation in generic prescribing across NHS primary care in England.

When to prescribe by brand

There are situations where prescribing by brand is necessary. Circumstances include:

Bioavailability differences

Where bioavailability differs between brands, particularly if the medicine has a narrow therapeutic index. Lack of clarity over which preparation is required can lead to the patient receiving a sub-therapeutic or toxic dose.

Examples include: ciclosporin, lithium, CFC-free beclometasone metered dose inhalers, carbamazepine for epilepsy

Release profile variations

Where modified release (MR) preparations are not interchangeable. Methylphenidate is an example.

Specific device directions

When administration devices have different instructions for use and patients require training to use them.

Examples include: adrenaline auto-injectors, dry powder inhalers, insulin injection devices

Biologics and biosimilars

The MHRA advises that biologic medicines, including biosimilar medicines, should be prescribed by brand name.

Examples include: insulins, enoxaparin, erythropoietin

When to consider prescribing by brand

Ensuring supply of a consistent product can be helpful in some other circumstances, depending on the products and the patient.

Multi-ingredient preparations

Where products contain more than one ingredient. Brand-name prescribing aids identification of the correct product.

Examples include: pancreatin supplements, skin or scalp preparations

Licence variations

Where branded and generic preparations have different licensed indications.

Generic preparations are licensed on the basis of bioequivalence with the branded product and it can be argued that brand-name prescribing is not necessary. However, The MHRA advise a medicine should not be used ‘off-label’ for an unlicensed indication when a licensed alternative exists.
Buprenorphine 400mcg sublingual tablets is an example where licensed indication differs between brands

Patient factors

For some patients, differences in product name, presentation, appearance or taste may lead to anxiety, confusion, dosing errors and reduced adherence.

Example medicines

Example medicines to prescribe by brand name in primary care

Prescribe certain medicines by brand to ensure supply of the same product. Examples are grouped by therapeutic area. The list of products is not exhaustive.