Thursday, January 24, 2013

Drug costs and free prescriptions

Audit Scotland has today published Prescribing in general practice in Scotland, its third report on the subject. It shows that NHS Scotland has improved how it manages prescribing in general practice during a period when it has faced considerable pressures.
GP prescribing accounts for 70% of all NHS spending on drugs in Scotland. This amounts to almost £1 billion a year. Spending fell by 11% in real terms between 2004 and 2011, despite the volume of prescriptions rising by a third during that time. The report says there is scope for further improvements and potential to save up to £26 million a year without affecting patient care. This could mostly be done through reducing waste and cutting the use of less suitable medicines.
While this is the headline from the study, I suspect many people will be interested in what the report has to say about the impact of free prescriptions. We already have ill informed comment from politicians who don't appear to have even read the report. Prescription charges in Scotland started to be phased out from April 2008 and were abolished in April 2011. The Scottish Government estimated that the total cost would be £73 million for the three years up to 2011/12, and £57 million in 2011/12 and in subsequent years. Critics argued that there is a risk that the abolition of prescription charges could lead to an increase in the overall quantity of prescribing beyond that anticipated.
The study says it is difficult to measure the impact of the abolition of prescription charges at present because:
·         the changes were brought in over a three-year period, making it difficult to identify a break point when trends changed;
·         the change took place against a background of increases in prescribing for many drugs;
·         over 90per cent of prescriptions were for people who were exempt from charges, making it difficult to distinguish any impact of the abolition of charges from overall trends;
·         changes to the community pharmacy contract make it difficult to assess the impact of drugs prescribed by community pharmacists under the Minor Ailment Scheme;
·         the total abolition of prescription charges took place in April 2011, too recently for our audit to identify emerging trends.
They did look at prescribing trends for three common drugs available to buy that are also available on prescription: paracetamol, ibuprofen (both painkillers), and antihistamines. They compared changes in prescribing trends for three years before and after April 2008 when prescription charges started to be phased out. They found that paracetamol went down by almost a half, Ibuprofen went up slightly and antihistamines almost trebled. The study argues that no trends can be observed, but an obvious conclusion is that paracetamol is very cheap and antihistamines expensive, so more worthwhile to get a prescription.

SHA Scotland long argued for free prescriptions, not least because some of those just outside the exempt category had to prioritise which drugs to take.  There is no evidence in this study that indicates that the policy is not viable.

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