Learning from the lamotrigine brand change

In September 2021, a joint project with the Ministry of Health, the Medical and Pharmacy Councils of New Zealand, the Royal New Zealand College of General Practitioners, and Pharmac started.

The aim – to improve how brand change information is shared across the health sector – is a key learning from the lamotrigine brand change.

Using generic medicines is one way we keep the prices of medicines down. On average, about 85 brand changes are made each year. This enables us to stretch New Zealand’s medicine budget even further.

Despite brand changes being common for many types of medication, there was a significant amount of public and media interest in the lamotrigine brand change in October 2019. The anticonvulsant medicine, predominantly used for the treatment of epilepsy, switched from three different brands to just one (Logem).

Lamotrigine is taken by about 12,500 people in New Zealand. About 40 percent of them use it for epilepsy. While the change in brand went smoothly for most people, suspected adverse reactions were reported. Tragically, seven people with epilepsy died during the months the brand change was happening. We commissioned an independent review into the lamotrigine brand change to consider whether our decision-making and implementation processes were appropriate – and what we could improve for future brand changes.

The independent review found that, while we had sufficient evidence to make the decision to move to one brand of lamotrigine, we could have consulted even further.

pills on a dispensing tray.

The coronial inquest that followed did not find a clear link between the brand change and the seven deaths. However, the Chief Coroner emphasised that sharing comprehensive information with people taking the medicines and health professionals is essential for a brand change – and there was more Pharmac could have done in this area.

“We are doing everything we can to ensure health professionals are informed of brand changes,” says Lisa. “The coroner’s comment that not all information about the brand change reached patients was valid and something we’re actively addressing.

“It will require team work across the health and disability sector, but we want patients and their health professionals to know when brands change and what options they have,” says Lisa. “We’ve been improving the information we develop for prescribers, and using social media and traditional media to highlight brand changes.

“We’re also working in partnership with other key parts of the health and disability sector to ensure the right people are passing the right information onto patients, and are looking forward to progressing this work in the coming months.

When one size doesn’t fit all

The lamotrigine brand change highlighted that some people can’t as easily transition to new medicines as others. To ensure decisions account for everyone, Pharmac introduced Principal Supply Status as an alternative to Sole Supply in July 2021.

While most people, with the support of their healthcare professionals, were able to change from one brand of lamotrigine to another, there were some who couldn’t transition as easily.

“We wanted a mechanism in place to support people who for whatever reason can’t change brands of medicines - so we introduced Principal Supply Status as an option for pharmaceutical providers,” says Director of Operations Lisa Williams.

In Sole Supply situation, medicines would only have one subsidised brand for a particular condition. To add more flexibility for patients and prescribers, Principal Supply Status means that, while a main brand gets the majority of funding, there is budget for other brands to supply small quantities to address individual situations.

“We want to minimise disruptions to at-risk people using medicines that work,” says Lisa.

“We believe this approach will allow Pharmac to better support healthcare professionals when prescribing medicines for their patients.”