As part of an information campaign—presumably to push down the manufacturer’s proposed price increase of metoprolol succinate (New Zealand's most preferred beta-blocker)—PHARMAC sent a four-page letter to general practitioners (GPs) outlining various options for changing medications in order to “ free up money for new drug investments.”

One option mentioned is to change patients from metoprolol succinate to carvedilol.

If GPs swap everybody on metoprolol succinate plus any diuretic or person with a hint of puffy ankles (i.e. with possible congestive heart failure) onto carvedilol, is PHARMAC better off or worse off financially?

Is the patient better off or worse off financially or physically as they return to the General Practice for blood pressure monitoring and titration changes? Is the General Practice supposed to absorb the nurses and doctors time costs because of increased patient benefits being rolled out on 1 July 2007? Is this a legitimate patient charge? Should the prescription for carvedilol be 3 months stat or 1 month and two repeats endorsed close control? Should the changed script be for 1 month only and require the patient to return to the General Practice and pay another fee for monitoring and review?

Is the pharmacist going to cost more in the short term or the long term to the patient or to the taxpayer? Carvedilol is nominally three times the price of metoprolol succinate according to the Pharmaceutical Schedule?

Is there a cap on the number of prescriptions for carvedilol before PHARMAC starts to see a heavy reduction in price per tablet? Where is the break-even point? Are GPs supposed to choose to change medications on the basis of the cost to the patient in part charges; the nominal drug cost to PHARMAC; the improved profit margin to the chemist; the increased services to the General Practice; the evidence for the particular drug in the literature; or what?

Who should benefit financially from the change and who should pay directly and indirectly for the changes to be implemented?

And how are GPs supposed to make a rational decision?