GPs urge action on illegal generic substitution
PEAK pharmacy bodies may soon tighten their guidelines on generic substitution, in response to growing GP concern that pharmacists are illegally dispensing generic medications against doctors’ orders.
The AMA has appealed to the Pharmaceutical Society of Australia (PSA) to amend its professional practice standards to explicitly rule out generic substitution when doctors have ticked the ‘brand substitution not permitted’ box on prescriptions.
Current standards state brand substitution may occur after consultation with, and agreement of, the patient and only if the prescriber has not ticked the box.
But Associate Professor John Gullotta, chair of the AMA therapeutics committee, said the standards should direct pharmacists to check whether the box had been ticked before they even began discussing the issue with patients.
Recent legal advice sought by the National Prescribing Service (NPS) on the issue has revealed unauthorised substitution is actually illegal, as prescriptions are considered legal documents and cannot be altered.
Any pharmacist who disregards instructions not to substitute is breaking the law. An NPS spokesperson said the body was not aware of any pharmacist being investigated or charged over generic substitution, but MO is aware that the Pharmacy Guild has been alerted to at least one case.
One pharmacy industry source told Inside Story this week that recent industry reforms had prompted a growth in the number of pharmacists resorting to unethical practices.
Professor Gullotta said unauthorised substitution raised important issues for patient care.
“For older patients on multiple medicines, substituting brands can lead to patient confusion... [and] there is the risk of double dosing. I see this regularly in my practice and, in a few cases, [this generic substitution] has led to hospitalisation.”
The PSA professional practice standards are up for review this year, and a spokesperson confirmed it was in discussions with the AMA regarding the issue.
He said pharmacy boards across Australia would act on any complaint by consumers or health professionals.
Meanwhile, South Australian GP and AMA council of general practice chair Dr Rod Pearce said his patients were citing increased pressure to switch brands.
“I am also concerned about the distress it seems to cause patients when they get asked, and the pressure to change,” he said.
Pharmacy Guild president Kos Sclavos said under PSA standards, pharmacists were expected to offer patients generic substitution where applicable. He said most complaints around the substitution issue arose when pharmacists did not offer it.