Pfizer could be facing a backlash from PCTs angered by the recent price rise on two of its leading products, Istin and Celebrex.

The company announced a 17.5% price rise for arthritis painkiller Celebrex and a 10% increase on hypertension treatment Istin in July, but could face a drop in sales if PCTs co-ordinate large-scale switches to other, cheaper products.

Norman Evans, Prescribing Advisor at Wandsworth PCT, is particularly incensed by the price increase on Istin, which is the Trust third-biggest drug by expenditure. "It will cost us £100,000 extra, which we haven budgeted for and hadn identified as a cost pressure," he said.

Mr Evans says he is particularly angered by how Pfizer raised prices one third of the way through a financial year, and without prior consultation He said: "We still haven had any official notification from Pfizer."

Although almost unheard of, post-launch price rises are allowed under the UK Pharmaceutical Price Regulation Scheme (PPRS), which limits the total profits a company can make from its products.

Anna Trevino, Product Communications Manager, Pfizer said: "It [the Istin price rise] is part of an ongoing business review to put prices up and down, and this has been done in conjunction with the PPRS."

"Even with the price rise, Istin is very competitively priced with reference to other medicines, and we believe it has a robust reputation due to its effectiveness and strong safety profile," she said.

"There are still choices [in the market place] and this is still a great product to use in the area of hypertension treatment."

Wandsworth PCT is now looking to recoup the money by instructing GPs to switch to alternatives wherever possible, and hopes the move will be registered as a protest.

"We now have three-year budgets and know exactly how much we have for this period, but we don plan for price increases it is very unusual for the PPRS to allow price increases," he said, adding: "We can allow the tail to wag the dog."

The sentiment is echoed by Ron Smith, Prescribing Advisor for East Cambridgeshire and Fenland PCT, who has already written to GPs regarding the Istin and Celebrex price rises, which he estimates will cost the PCT an extra £50,000 a year if no action is taken.

Mr Smith confirmed the PCT was displeased at what he called Pfizer leight of handsaying:  "I wouldn say it a boycott, but it certainly a protest. Here is the largest pharmaceutical company in the world looking to rip off the NHS, in my view."

Mr Smith has now written to the PCT doctors advising them to switch to rival calcium channel blockers, Napp Zandip and AstraZeneca Plendil, which were considerably cheaper even before Pfizer price rise.

Istin was the fifth biggest-selling drug in England last year, with the NHS spending over £140 million on the drug, which is due to go off-patent in 2004.

Mr Smith letter also sets out the alternatives to Celebrex, including its biggest competitor Merck Sharp & Dohme Vioxx. The price rise brings the 200mg daily dose of Celebrex within three pence of parity with the standard 25mg dose of Vioxx at £21.55, but its 400mg dose now costs over £43 for a month supply.

Mr Smith says he is sure Pfizer could have anticipated PCTs displeasure, but probably calculated that many doctors will not be inclined to switch patients particularly hypertension patients whose condition is stable on their current medication.

Mr Evans says Wandsworth PCT is fortunate in being within its prescribing budget, but knows many PCTs are struggling to control spending fuelled by NICE recommendations and the National Service Frameworks.

"I  would like to work with the industry because I feel that we have a common goal but when we are treated with disdain like this, it beggars belief," he says. "We have to work together but this sets us all back."

pharmafocus@pharmafile.co.uk