The Federal Government has zeroed in on boosting generic substitution in a class of popular cholesterol drugs as a way of lowering the burden on public coffers.
In a speech to the Committee for Economic Development of Australia's Health Reform Forum in Sydney earlier this week, Health Minister Nicola Roxon called on prescribers to exercise "clinical leadership" when choosing what statin to prescribe.
"Most patients with high cholesterol can be successfully managed with commonly available generic statins, which cost the PBS about $30 to $40 for a typical pack," Ms Roxon told the forum.
"Only some patients require more expensive medicines which cost up to $80 for a typical pack. In practice, though, about three quarters of prescriptions are for the more expensive medicines, and only a quarter are for the cheaper generic."
According to Pharmacy Guild president Kos Sclavos, however, statin substitution was outside the influence of pharmacists because popular brands like Lipitor and Crestor were still under patent and could not be substituted when prescribed, unlike other simvastatin and pravastatin molecules.
"Our responsibility comes in when the prescription lands in a pharmacy," he told Pharmacy News.
"But overseas pharmacists are paid to convert people to drugs in the same class. That would be a radical step here in Australia and I know it would be fiercely fought by the doctors."
Mr Sclavos said no pharmacist incentives could alter generic substitution rates when a specific brand is prescribed by the doctor.
"The doctor can influence the patient to never take a generic and it doesn't matter what incentives there are to a pharmacist," he said.
"We will never get to 100 per cent substitution because sometimes doctors have a real impact on a patient.
"The other unique thing about Australia is that it is a brand-driven mentality. In the UK, for example, drugs are written generically which makes generic substitution easier.
"That issue came up for debate during the PBS reform process and it was fiercely opposed by the doctor groups."
Mr Sclavos, however, raising doubts that any changes to the class substitution framework were on the agenda.
"I got a sense of frustration from the Minister and on many days I share that frustration," he said.