Generic prescribing uses the recommended International Non-proprietary Name (rINN).
Brand prescribing uses the branded (proprietary) or branded generic name.
Benefits of generic prescribing
Generic prescribing is generally preferred. This is because it:
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:
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.
Where products contain more than one ingredient. Brand-name prescribing aids identification of the correct product.
Examples include: pancreatin supplements, skin or scalp preparations
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
For some patients, differences in product name, presentation, appearance or taste may lead to anxiety, confusion, dosing errors and reduced adherence.