The Pharmaceutical Journal
Vol 279 No 7475 p467
27 October 2007

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• Fees consultation (2)
• Community pharmacy
• Pack sizes (3)

Letters to the Editor

Pack sizes

A 28-day pack size policy would improve safety

From Mr A. A. Patel, MRPharmS

So Bristol-Myers Squibb/Sanofi-Aventis is changing the pack size of Plavix from 28 to 30 (PJ, 29 September, p346). Like many of my colleagues, I am annoyed by this decision because most prescriptions are for multiples of 28.

There is a safety issue around 30-day packs, due to the requirement of having to cut strips. It is also confusing for patients because if GPs try to help them by prescribing original packs, the patient will be left with packs of 28 and packs of 30 and will run out of medicines at different times.

The National Patient Safety Agency, the Medicines and Healthcare products Regulatory Agency and the Committee on Safety of Medicines should implement a 28-day pack size policy for all medicines, with exemptions for some, such as methotrexate or antibiotics.

If companies would stick to a 28-day pack policy, there would be better patient compliance, improved safety and more time for pharmacists to undertake new roles, such as medicines use review.

Ahmed Patel
Batley, West Yorkshire

Extremely annoying for pharmacists

From Mr J. M. Strachan, MRPharmS

I can imagine it now. Across a boardroom meeting in Bristol-Myers Squibb/Sanofi-Aventis came the question (PJ, 29 September, p346): “How can we raise our profitability even more?” A resounding answer came.

“Why not increase the 28 calendar pack of Plavix to 30, and adjust the price upwards by £2.52 and we’ll keep the pack looking exactly the same?” This was greeted by much applause.

The tea lady who happened to be in the room at the time and whose son was a pharmacist piped up: “Would this not inconvenience the dispensing process as the majority of patient packs are in 28s and most repeat quantities are in multiples of 28?

“This may require cutting of packs and if 30 were dispensed each time, the patient would build up excess quantities of Plavix gradually, hence causing confusion when it came to ordering. Some pharmacists might not notice the change and lose out on £2.52 each time a pack was dispensed.

“In fact would it not be better to try to help the pharmacy profession at a time when so many factors are going against them from the emergence of the new Pfizer distribution agreements, which have reduced the margin of discount to such an extent that they are actually losing money, to the increasing clawbacks on their generic drug tariffs?

“Could you not try to help pharmacy in these times instead of introducing another pitiful method of lining your own pockets?”

No one in the boardroom took any cups of tea that day.

John Strachan
Macduff, Banffshire

Can common sense finally prevail?

From Mr M. Spencer, MRPharmS

I have never understood why it is so difficult for drug companies to get their heads together and finally decide just how many days make up a month. The majority seem (logically) to opt for 28 days, as do the majority of GPs when writing prescriptions. It becomes confusing for patients and extremely annoying for pharmacists when medicines are supplied in packs of 30.

My staff have enough on their plates without the unnecessary hassle of searching for the scissors and snipping and spoiling packs to supply a request for 28 days’ medication when the pack contains 30.

How then can Bristol-Myers Squibb justify changing the pack size of Plavix from 28 to 30 (PJ, 29 September 2007, p346)? Prescriptions are always written for 28; I cannot ever remember receiving one for 30.

A similar problem occurred some time ago when paroxetine and fluoxetine were no longer recognised as calendar or special packs.

Again, a prescription for 28 results in a scramble for the scissors and a situation that can only increase the chances of dispensing mistakes being made as a result of the break in concentration that can arise. Patients end up with an unprofessional final product. And then there is the problem of information leaflets.

Glaxo is another company that persists in providing 30 and 60 pack sizes.

Please can somebody, somewhere, ensure that common sense can finally prevail?

Mike Spencer
Stockport, Cheshire

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