§ Mr. Michael Morrisasked the Secretary of State for Social Services what new evidence persuaded him to reject the recommendation of paragraph 25 of the Greenfield report on generic prescribing in favour of the introduction of a limited list.
§ Mr. Kenneth ClarkeParagraph 25 of the Greenfield report on effective prescribing recommended rejection of a limited list of drugs across all therapeutic categories primarily on the grounds that the financial benefits were unproven. Our limited list proposals cover only a small number of therapeutic categories containing simple remedies and benzodiazepine sedatives and tranquillisers. Our proposals are the result of further detailed investigations and inquiries which show that in other countries with similar arrangements savings have been immediate and worthwhile and no damage has been caused to patient care.
§ Mr. Michael Morrisasked the Secretary of State for Social Services (1) which other countries have limited list drug schemes;
(2) whether any research was done prior to the announcement on 8 November of his proposals for limited list prescribing of such schemes in (a) Denmark, (b) New Zealand, (c) Australia and (d) West Germany.
§ Mr. Kenneth ClarkeLimited list drug schemes have been introduced by most countries with advanced health care systems including Australia, Belgium, France, West Germany, Ireland, Denmark, Norway, Sweden, the Netherlands, Italy, Portugal, Spain and New Zealand. We have studied the operation of most of these schemes in depth.
§ Mr. Michael Morrisasked the Secretary of State for Social Services how he proposes to evaluate the therapeutic equivalence between a branded and a generic product.
§ Mr. Kenneth ClarkeWhen we reach final decisions on the range of drugs prescribable at public expense in a 319W small number of therapeutic categories, we do not intend to provide a direct generic equivalent to every branded product. Instead, an adequate range of effective, alternative, low cost generic products will be available on the NHS. On the general question of efficacy, I refer my hon. Friend to my reply to the hon. Member for Carmarthen (Dr. Thomas) on 4 December at column 163.
§ Mr. Michael Morrisasked the Secretary of State for Social Services (1) what safeguards there will be for those patients who at present have free prescriptions to ensure that they can still obtain branded products;
(2) what safeguards he proposes to protect the position of chronically sick patients who are currently receiving branded drug products following the introduction of the limited list scheme;
(3) if he will make it his policy to ensure that the introduction of limited list prescribing does not lead to a system of two-tier medicine in the National Health Service.
§ Mr. Kenneth ClarkeWe intend to produce a limited list which will cover all clinical needs. In drawing up the final version of this list, we need the help of the medical and pharmaceutical professions and the drugs industry, and we will be discussing the details fully and carefully with them. This consultation will serve to ensure that medicines which are essential for the treatment of particular conditions are not excluded from NHS use.
§ Mr. McNamaraasked the Secretary of State for Social Services how many firms manufacturing which pharmaceuticals have written to him following his proposal to limit the range of drugs available on prescription from the National Health Service.
§ Mr. Kenneth ClarkeSixteen companies manufacturing drugs likely to be affected by the proposal have written to us.
§ Mr. McNamaraasked the Secretary of State for Social Services (1) what proportion of the range of drugs which he proposes to cease being available on National Health Service prescriptions are manufactured in the United Kingdom; and how many are imported;
(2) when he proposes to list those pharmaceuticals and inform their manufacturers which will no longer qualify for the National Health Service list of prescribed drugs.
§ Mr. Kenneth ClarkeThe limited list of drugs in certain therapeutic categories to be used for National Health Service prescribing will not be finalised until after the consultation period ends on 31 January 1985.
§ Mr. McNamaraasked the Secretary of State for Social Services what estimate he has made of the number of jobs in the United Kingdom, by company, dependent upon the manufacture of pharmaceuticals he is proposing should cease to be available for prescription by the National Health Service.
§ Mr. Kenneth ClarkeI refer the hon. Member to my reply to the hon. Member for Portsmouth, South (Mr. Hancock) on 4 December at column166.
§ Mr. McNamaraasked the Secretary of State for Social Services how many representations he has received, and from whom, criticising his decision to reduce the number of drugs available for prescription on the National Health Service.
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§ Mr. Kenneth ClarkeWe have received over 250 letters criticising the proposals in some way. The majority of these have been forwarded by hon. Members on behalf of constituents and represent opinions from the medical and pharmaceutical professions, the pharmaceutical industry and the general public. Many are no more than copies of circular letters put out to all general practitioners by one of the drug companies, Roche Products Ltd.
We are also of course receiving letters in support of the proposals, mainly from members of the medical profession.
§ Mr. McNamaraasked the Secretary of State for Social Services what proposals he has to discuss with representatives of the medical professions, and trade unions representing employees of manufacturers, his proposals to limit the range and number of drugs that can be obtained by prescription on the National Health Service.
§ Mr. Kenneth ClarkeFull and careful consultation is taking place with the pharmaceutical profession. the medical professions and the pharmaceutical industry. My right hon. Friend the Secretary of State and I met with representatives of the British Medical Association yesterday. We have no plans to discuss the proposals with trade unions representing employees in the pharmaceutical industry as we are consulting medical and pharmaceutical opinion to decide on the final contents of a list which will cover all the clinical needs of patients.
§ Mr. McNamaraasked the Secretary of State for Social Services how many, and which, drugs proposed to be excluded from the list of approved drugs for prescription on the National Health Service contain one or more active ingredients not available on the list of permitted generic drugs.
§ Mr. Kenneth ClarkeThe drugs to be available on the National Health Service in the categories affected by the limited list proposals will not be finalised until full consultation has taken place. In the meantime it is not possible to identify any active ingredients that will not be available after 1 April 1985.
§ Mr. Hancockasked the Secretary of State for Social Services what assessment he has made of the future export potential of United Kingdom drugs manufacturers whose products will no longer be readily available in the National Health Service following the introduction of limited list prescribing.
§ Mr. Kenneth ClarkeWe are not aware that exports of drugs will be seriously affected by the limited restrictions we propose to apply to NHS prescribing.
§ Mr. Hancockasked the Secretary of State for Social Services whether he will take steps to invest the National Health Service with total product liability for drugs imported from other countries, following the introduction of limited list prescribing.
§ Mr. Kenneth ClarkeNo. The Government are discussing with other members of the European Community a draft directive for general product liability, prepared by the European Commission, for application in Member States. The introduction of limited list prescribing does not affect the Government's position on this.
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§ Mr. Hancockasked the Secretary of State for Social Services what assessment he has made of the impact of limited list prescribing (a) on the profitability of pharmaceutical companies and (b) on employment in the industry.
§ Mr. Kenneth ClarkeThe effect of the limited prescribing list proposals on both profits and jobs will depend on the composition of the final list of drugs which may be prescribed and how well companies are able to recoup in other ways sales lost to the National Health Service.