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End pharmacists’ monopoly on drugs, argues professor

Expert calls for a two-tier US-style system

Jo Carlowe

Thursday, 02 July 2015

The pharmacists’ monopoly on selling some drugs should end and be replaced with a US-style system.

Writing in The BMJ* this week, Professor Paul Rutter at the School of Pharmacy, University of Wolverhampton, says a two tier system of prescription or non-prescription drugs, like in the US, would be simpler.

Evidence is lacking, he says, that having a category of drugs that can be sold only by pharmacists or under their supervision (“pharmacy medicines”) has benefits.

Professor Rutter cites the recent case of the painkiller, oral diclofenac, that used to be available as a non-prescription drug sold exclusively under the direction of a pharmacist. In January 2015, the UK drugs regulator (MRHA) announced that it would revert to a prescription-only drug “because of a small but notably increased risk of cardiovascular side effects.”

This implies that, even with this system of restricted availability, “doubt exists that pharmacists (and their staff) can supervise sales to consumers appropriately,” writes Rutter.

Given this decision, should any drugs still be restricted to sale only with a pharmacist’s supervision, he asks?

Some may argue that the pharmacy medicines category helps pharmacists in the community to help patients care for themselves, thereby reducing doctors’ workloads, adds Rutter. “But does their four to six years of drug training mean that they should have a monopoly on selling some drugs?” he writes.

Furthermore, if pharmacy is to hold a monopoly on selling some medicines, it needs to show value to consumers in terms of health outcomes, when compared with consumers purchasing these drugs without restriction, he argues.

He points out that in the UK, in the past four years, just three drugs were switched from prescription-only control to pharmacy medicine status, but 12 pharmacy medicines were switched to general retail sale.

Without credible evidence to support the pharmacy medicines monopoly - namely, that pharmacy intervention improves patient outcomes - “it is only a matter of time before a two-tier system of prescription or non-prescription drugs becomes the standard model, as in the US,” argues Rutter.

Such a system, he concludes, is easy to understand: access to medicines is obtained either with a prescription or from any retail outlet. “This is less confusing for consumers and increases accessibility, but it still allows pharmacies to sell drugs and gives them a chance to demonstrate their worth.”

* Paul Rutter. End pharmacists’ monopoly on selling certain drugs. The BMJ 2015;351:h3415. doi: 10.1136/bmj.h3415

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