AMA Survey of GPs Debunks Minister's Blame Game With Doctors Over PBS Prescribing

The AMA believes that where appropriately used, generic drugs can produce savings on medication to the taxpayer from the Pharmaceutical Benefits Scheme (PBS), but those savings must be retained in the PBS. Currently, those savings are not being made by the Government.

The survey shows that GPs will rigorously exercise their professional judgement to prescribe a brand drug where they think it is most appropriate for the individual patient. Doctors have no other incentive for what they prescribe than the best choice for the patient and the best interests of the patient.

The fax survey was sent out to 1500 doctors in April 2006, with 386 replies being received - a response rate of around 25 per cent.

The key finding of the survey was that 80 per cent of GPs only tick the 'not for substitution' box on the prescription between 0-25 per cent of the time. In other words, for 80 per cent of GPs, pharmacists can substitute a generic drug, if there is one available, between 75-100 per cent of the time.

AMA President, Dr Mukesh Haikerwal, said today the survey shows that GPs are behaving responsibly in their prescribing patterns and patients are getting the most appropriate drug for their condition, contrary to claims made by Health Minister, Tony Abbott, this week.

"In his attempts to save money on the Pharmaceutical Benefits Scheme (PBS), the Minister is signalling that he wants to compel doctors to change prescribing habits without first consulting with them about a policy that could lead to potentially dangerous practice," Dr Haikerwal said.

"There is no place for the Minister in the surgery telling doctors what they can and cannot prescribe for every patient. It is outrageous and dangerous for him to seek to limit the prescribing decisions and options available to doctors - that is simply bad medicine.

"And the Minister is doing patients no favours by saying they can't have access to the specific medicines that may be the best for their particular ailment.

"The issue of PBS expenditure on generics is largely an issue between the Government and the pharmacists who dispense the drugs.

"Our survey suggests that the decision on whether the prescribed drug is a brand or a generic is most commonly made at the pharmacy counter, and that is where the Minister should be conducting his investigations."

Dr Haikerwal said that where GPs don't allow substitution, they do it for the responsible reasons of patient safety, patient compliance with prescribing decisions, clinical considerations, or at the request of the patient.

"They do it to prevent confusion and possible doubling up on doses, or worse," Dr Haikerwal said.

"Consistency in prescribing is important.

"Doctors decide for good reason not to allow substitution, but there are indications that pharmacists often ignore this decision.

"According to our survey, 75 per cent of GPs believe there are instances where the pharmacist substitutes against their advice, and 40 per cent of GPs believe this happens in up to one in four of their 'not for substitution' scripts," Dr Haikerwal said.

The survey shows that GPs are finding out about medicine substitution through various means, including:

• when their patient has an adverse reaction, and
• when the patient comes back for the next script, but
• only 16 per cent of GPs surveyed reported that they found about it through contact from the pharmacist.

Dr Haikerwal said the survey is compelling evidence that doctors are behaving responsibly in their prescribing habits.

"We know that doctors have no vested interest in their prescribing decisions other than patient well-being," Dr Haikerwal said.

"However, our survey indicates that GP decisions based on patient safety and the quality use of medicines are frequently not being followed through when dispensed.

"If the Minister wants to get to the truth on brand substitution in PBS prescribing, he should be talking to the medical profession and not the media.

"It is absurd that doctors, the people responsible for prescribing and who would take the consequences of the collateral damage of such action, have consistently been disregarded in the Minister's convoluted deliberations.

"If he's looking for someone to blame, the Minister has to start looking in places other than GP surgeries.

"He must remember that the doctors are part of the solution, not the problem, and he must also remember medication is an investment in the future - an integral part of preventive health care - and not simply an expense."

For full details of the AMA Brand Substitution Survey follow the link.