Slight use of medical necessity on prescription


‘Medical necessity’ on a prescription means that a doctor finds it necessary for medical reasons to prescribe a particular drug brand

It is rare to prescribe “with medical necessity” prescriptions; this is less than 3% of all prescriptions issued by the pharmacy. When the general practitioner prescribes a prescription ‘with medical necessity’, the patient is entitled to exactly the mark prescribed by the doctor; the pharmacist is then obliged to dispense the product of that brand. The main reason for prescribing on medical necessity is the patient’s request. These findings stem from Nivel’s exploratory research into the scope and rationale for applying medical necessity to a prescription.

‘Medical necessity’ on a prescription means that a doctor finds it necessary for medical reasons to prescribe a particular drug brand. This also applies in cases where the brand in question is not the right brand, for example because another brand is cheaper. Until now, much has been unclear about the extent to which this is happening and what the reasons are for prescribing based on medical necessity. Nivel has mapped the extent and causes using figures from the Foundation for Medicinal Key Figures (SFK) and interviews with general practitioners and pharmacists.

‘Medical necessity’ is rarely used
The SFK figures show that the statement ‘medical necessity’ on dispensations at pharmacies occurred in 2.9% of all dispensations. In the first issues, this percentage was below 1%.

The general practitioners prescribe medical necessity to maintain a good relationship with the patient
For GPs, the relationship with the patient is central to the use of ‘medical necessity’. If a patient sticks to a particular drug and refuses to change brand, GPs tend to indicate “medical necessity” on the prescription. Some GPs refer the patient to the pharmacy because they believe that this is where the decision-making power lies when it comes to dispensing a prescription based on medical necessity.

Pharmacists check if medical necessity is required on the prescription
Without exception, the interviewed pharmacists have indicated that they do not always simply follow an indication of ‘medical necessity’. They will discuss this with both the patient and the doctor. The consideration here is that there is almost never an ‘objective’ medical necessity. It is also a financial consequence for the pharmacy to dispense prescriptions too often on the basis of medical necessity.

About the research
The study, which was commissioned by the Ministry of Health, Welfare and Sport, consisted of a quantitative and a qualitative part. For the quantitative part, two databases were consulted in the study: the Foundation for Pharmaceutical Key Figures (SFK) and Nivel Primary Care Registrations. For the qualitative part, a total of 8 interviews were conducted with general practitioners and 12 interviews with pharmacists. The interviews conducted online were conducted using a pre-prepared topic list.

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Original title: Prescription medical necessity is rarely used
Audience: Healthcare professionals, policy makers, informal caregivers, students
Date: 2022-05-23

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