Medication brand changes: highlighting systemic issues with ongoing risks to consumers

In 2020, HDC received a number of complaints from consumers raising concerns about Pharmac’s decision to change the funded brand of lamotrigine, a medication used to treat epilepsy and bipolar disorder.

Prior to the change, lamotrigine was available from Logem, Lamictal, and Arrow-Lamotrigine, and, after the change, from Logem only. The previous Health and Disability Commissioner, Anthony Hill, carried out the initial assessment of these complaints, and the work was carried on by Morag McDowell from September 2020.

As part of the process, a significant amount of information was obtained from consumers, prescribers, pharmacists, and Pharmac, and publicly available information was also considered. It was found that a lack of clarity exists about who is responsible for managing and communicating brand changes to consumers, with a blurred line between Pharmac, prescribers, and pharmacists.

Concerns were also raised about the potential for significant adverse effects for some consumers — many of whom may be particularly vulnerable — as a result of a medication brand change. Mixed views and concerns were raised by different parts of the sector about their roles and responsibilities, with some GPs reporting that they do not consider it part of their role to inform patients of brand changes, and rely on pharmacists to communicate this to consumers at the time the medication is dispensed to them. Concerns were also raised about the relative inaccessibility of notifications about brand changes, which meant that some prescribers were unaware that they had happened.

The Commissioner took the step of writing to the Director-General of Health to outline her concerns, particularly as it is essential that healthcare providers are informed appropriately, so that they can communicate effectively with their patients and manage risks. As a result, the Ministry of Health is undertaking a review of Pharmac’s approach to communicating changes.

HDC looks forward to the outcome of this work, so that the sector, and people receiving health services, have access to timely, consistent, and accurate information. The Commissioner’s letter and the Director-General of Health’s reply are available here.