UK BLACKLIST and a "TWO-TIER" NHS

The UK government's proposals to extend the National Health Service prescribing blacklist to ten further therapeutic categories (Marketletter November 23, 1992) will herald the development of a two-tier health care service, says a correspondent writing in General Practitioner magazine.

General practitioner Ian McKee from Edinburgh says that more affluent patients will pay for medication recommended by their doctor if it is on the blacklist, but those on low incomes, who cannot afford regular supplies of medication, "will have to accept what they know their doctor feels to be second-best treatment."

Dr McKee says the government is rumored to want to reduce the 35 oral contraceptives now available on the NHS to ten. The newer pills, such as the ethinylestradiol/gestodene products Femodene from Schering AG and Wyeth's Minulet, offer real advantages to patients, appearing to offer some protection against breast cancer, but they are three times more expensive to prescribe. Moreover, says Dr McKee, the practice of changing a cheap contraceptive pill to one of the newer products when side-effects occur may have to be ended.