The ARA has advised its members to prescribe infliximab by brand name and consider ticking the ‘brand substitution not permitted’ box on prescriptions.

In a letter to its members President Dr Mona Marabani said that while the ARA supported moves to ensure value for money for the PBS it remained concerned about the decision to allow Inflectra^® and Remicade^® to be deemed interchangeable at the point of dispensing.

“Our concerns centre particularly around the potential for immunogenicity as there is no evidence that repeated switching is safe or that efficacy will not be compromised,” the letter said.

When prescribing doctors should consider ticking the brand substitution not permitted box at the top of the prescription, the letter advised.

“The pharmacist must then dispense the drug you have written – your choice of either the originator or the biosimilar- otherwise legally they MUST contact you,” it said.

As Australia has not adopted a naming convention for these drugs, the letter also advised prescribing by brand name.

“If you prescribe ‘infliximab’ or you prescribe by brand name and do not ‘tick the box’, the patient may be dispensed EITHER Inflectra^® OR Remicade^® each and every time they present to the pharmacy,” the letter warned.

Patients and infusion centres should be encouraged to keep packaging or photograph the actual medicine dispensed and its barcode and bring this to every consultation.

Doctors should also check with your hospital pharmacy, drug committee or infusion centre to find out how they will be dealing with this and ensure you know which drug your patient will be administered.

“In some jurisdictions, state-wide purchasing may determine what every hospital patient will receive, so there is potential for large-scale one-way switching,” it said.