Update July 2018: Looking at current data, these look like presentations which had been withdrawn for whatever reason, but prescriptions were lagging (e.g. repeat prescriptions from dormant practices, etc). For example Acupan, the last example below, is no longer prescribed at all. If this is the case, I would still like to understand what it means for something to be "not available" in DM+D. If Accupan is no longer manufactured, how do dispensers fill the prescription?
There are many cases where an AMP has no available AMPPs listed in dm+d, yet it is appearing in the prescribing data.
There are often significant price-per-quantity savings suggested by switching from the generic to the brand presentation, but the branded prescribing is in very low quantities (usually over long periods of time), which suggests either a real possible saving that people don't know about, or an error in the data.
This matters for two reasons. (1) if the brand isn't really available (it's an obscure loophole, or an error in the data), then these savings might not be achievable; (2) if the brand is really available, but hardy anyone knows about it, then the possible cost savings will not appear in our calculations at all (see the Acupan example at the bottom of this note).
I'm not sure this is an error in the data, because (from spot checking) all these examples seem to be available from online pharmacies at the "low" prices we see in the data. Also, the "error" rate appears consistent every month over many months.
The quantity prescribed by brand is always low-level in the examples I've found. Perhaps they represent written prescriptions rather than e-prescriptions, as the latter will be using dm+d as a basis for offering choices. Another possibility is that they are some kind of repeat prescription.
It would be good to confirm:
if/when/why dm+d does not reflect what's actually available
what would happen if a GP prescribed a brand not listed in dm+d but available elsewhere (e.g. an online pharmacy)
what would happen if a GP prescribed a brand not listed in dm+d but unavailable elsewhere
I suspect we'll need to refer the first question to BSA (perhaps with these examples). @richiecroker probably knows the answer to the other two...
The particularly interesting example is "Acupan 30mg tablets". These are not listed as available in DM+D, presumably leading to their very low level of prescribing (see graph). This level of prescribing which is so low as to not figure in our price-per-quantity calculations. Yet this is a drug where the spending has gone through the roof:
It has a £2.4m monthly spending, with a potential £2.2m saving per month, and is available from online pharmacies at the lower rate.
There are many cases where an AMP has no available AMPPs listed in dm+d, yet it is appearing in the prescribing data.
There are often significant price-per-quantity savings suggested by switching from the generic to the brand presentation, but the branded prescribing is in very low quantities (usually over long periods of time), which suggests either a real possible saving that people don't know about, or an error in the data.
This matters for two reasons. (1) if the brand isn't really available (it's an obscure loophole, or an error in the data), then these savings might not be achievable; (2) if the brand is really available, but hardy anyone knows about it, then the possible cost savings will not appear in our calculations at all (see the Acupan example at the bottom of this note).
I'm not sure this is an error in the data, because (from spot checking) all these examples seem to be available from online pharmacies at the "low" prices we see in the data. Also, the "error" rate appears consistent every month over many months.
The quantity prescribed by brand is always low-level in the examples I've found. Perhaps they represent written prescriptions rather than e-prescriptions, as the latter will be using dm+d as a basis for offering choices. Another possibility is that they are some kind of repeat prescription.
It would be good to confirm:
I suspect we'll need to refer the first question to BSA (perhaps with these examples). @richiecroker probably knows the answer to the other two...
Examples
There are two AMPs listed for Buccastem 3mg tablets. They were both discontinued some time ago:
However, we are still seeing it being prescribed (graph) (the left-most column):
Though looking at this again, I can't see prescribing in our analyse charts... so I wonder if this is a bug in PPU?
Further examples:
The particularly interesting example is "Acupan 30mg tablets". These are not listed as available in DM+D, presumably leading to their very low level of prescribing (see graph). This level of prescribing which is so low as to not figure in our price-per-quantity calculations. Yet this is a drug where the spending has gone through the roof:
It has a £2.4m monthly spending, with a potential £2.2m saving per month, and is available from online pharmacies at the lower rate.