Analysis of the total costs of anti-psychotic medication prescribing in primary care in england highlights large impact of recent generic medication price increases.

Introduction: Oral anti-psychotic medication prescribed in primary care is a major treatment in mental illness. Since 2014 most 2nd generation anti-psychotics agents have been available through generic prescription. In 2017_18 certain generic mediations were subject to substantial price increases. Objectives: Quantify impact of changes in unit costs in primary care for main anti-psychotic medications on overall resources used and see whether this adverse situation was continuing. Methods: Monthly prescribing in primary care was consolidated by converting quantity amounts to total defined daily doses (DDD) using the factors published by WHO/ATC. Results: In 2018_19,10 million prescriptions containing 136 million DDD at costs of £110 million average £0.81/DDD were issued in primary care. The unforeseen price rises in 2017_18 caused a sharp increase in overall prices and had not reduced to the expected levels by 3rd quarter of 2019 as shown in Figure 1. Trend in average unit price in Figure 2 shows the unexpected price increases, now being reduced in Quetiapine and Olanzapine. However price increases in Chlorpromazine, Haloperidol, Amisulpride and Risperidone continue. If lowest average quarterly unit price of each medication in last 3 years are taken as benchmarks, the total costs difference between actual unit costs and the total volume prescribed multiplied by benchmark was £180 million in 3 years, 80% above the expected costs. This the equivalent to around £100/year/patient a significant sum. Conclusions: While the growth generic medication brings substantial cost advantages it also brings significant risks in supply and cost forecasting, and these rapid changes can put pressure on clinical behaviour and so patient outcomes. [ABSTRACT FROM AUTHOR]