Impact of measures to encourage generics prescribing in Scotland

Since 2000, measures have been introduced in Scotland in order to encourage use of generic rather than brand-name proton pump inhibitors (PPIs) and statins. The impact of these measures on the prescribing practices in Scotland has been positive. Generics use has increased, and costs for the Scottish government have decreased.

Measures introduced since the year 2000 have been categorised in Scotland under the four ‘E’s: education, engineering, economics and enforcement. The measures include educating physicians, introduction of prescribing guidance, regional formularies, monitoring of prescribing practices, efficiency and quality targets and financial incentives, see Table 1.

Table 1: Measures introduced in Scotland between 2001 and 2007 to encourage prescribing of generic PPIs and statins.

Measure	Initiatives
Education	Physicians trained in medical school to prescribe by international non-proprietary name (INN)* Introduction of decision-support software National guidance and guidelines Regional formularies advocating generics Monitoring of prescribing practices * Current INN prescribing rates across all products including PPIs and statins have reached an average of 80%. For generic simvastatin and lisinopril, INN prescribing rates have risen to more than 98%.
Engineering	‘Better Care, Better Value’ indicators to enhance prescribing of generics Quality targets for statin prescribing Quality and outcome framework (QoF) targets for diabetes, hypertension, stroke and coronary heart disease Encouraging substitution by pharmacists
Economics	Financial incentives for health boards Payments as part of the QoF scheme
Enforcement	Defined as regulations by law, currently do not apply to measures in Scotland

Use of the measures introduced in Scotland, along with a decrease in the price of generics in Scotland–attributed mainly to increased transparency in the pricing of generics–has led to a decrease in expenditure on PPIs, see Table 1. This comes despite a more than two-fold increase in use of PPIs during 2001 to 2007.

Scotland’s use of such measures to control medicine costs makes it stand out from other countries. For example, use of esomeprazole, where no generics yet exist, was 7% of total PPI use in 2007 compared to over 20% in countries such as France and Ireland where only limited measures to combat industry pressures are in place. This has mainly been attributed to the increased use of generic omeprazole since it became available in 2002. The patents on esomeprazole are due to expire in Europe in 2014.

The same pattern was seen for statins, with increased use of generic simvastatin versus other brand-name statins since the introduction of generics in 2003. Despite a five-fold increase in statin use in Scotland, expenditure on statins increased by only 16% in 2007 compared to 2001.

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Prescribing of generic PPIs and statins in Scotland

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