Contracting of Branded Medicines

1. Contracting of Branded Medicines Philip Aubrey Chair – Branded Medicines Sub Group of PMSG PDIG Symposium 10th Nov 2011

2. Introduction • How are branded medicines currently tendered and recent changes? • What is therapeutic tendering? • Branded medicines on therapeutic tenders? • How can we successfully implement therapeutic rationalisation? • Therapeutic tendering – case studies? • What does the future look like?

3. Tendering of Branded Medicines • Historically conducted at SHA level • NHS CMU conducts all tenders – excluding Y&H therapeutic tender • 2011 – now national contract for agreed list of branded medicines - covers all England including Y&H • Contract commences 1st Dec 2011 for 2 years with an option to extend for a further 2 years • Therapeutic tenders at SHA level – usually 1 year with option to extend for a further 1 year

4. What is Therapeutic tendering • The tendering of medicines within specific therapeutic classes • Although not all medicines are the same they can have similar efficacy, safety profiles and clinical evidence • Stakeholder engagement and robust clinical evaluations are key to therapeutic tendering • Suppliers have the opportunity to tender differential pricing on volumes within a therapeutic market • Suppliers – risks and opportunities

5. Therapeutic Tendering Matrix

6. Stakeholder Engagement PCT Pharmaceutical Advisors Trust LPP Pharmacy Leads Hospital Clinicians /GPs NHS CMU LPP MUPP Steering Group Commissioners Formulary Pharmacists Clinical Pharmacists Procurement Pharmacists

7. Branded Medicines on Therapeutic Tenders • Anti TNFs • Antiretrovirals • Antifungals • Botulinum toxin • Erythropoesis stimulating agents • Fibrinolytics • GCSF • Gonadorelin analogues • Growth Hormone • Hepatitis C • Oral anticoagulants

8. How can we successfully implement therapeutic rationalisation • Comprehensive stakeholder engagement • Supplier conditioning to explain our objectives and therapeutic tendering models • Clinical input into decision making • Formation of agreed clinical guidelines • Provide NHS trusts with projected cost efficiency savings • Recommendations to NHS trusts on how to implement locally • Regular monthly tracking of volumes, savings and lost opportunity data

9. Case Studies

10. Pan London Antiretroviral Therapeutic Tender 2011 - a clinical exercise • Traditional tender and therapeutic tender • Suppliers asked to submit prices related to various volume thresholds • Adjudication panel includes: • Medicine Procurement Specialists • Pharmaceutical Advisor to LSCG • Lead HIV Clinicians • Lead HIV Pharmacists • Commissioners • Patient Group Representatives • Facilitated by NHS CMU

11. Pan London Antiretroviral Therapeutic Tender 2011 – a clinical exercise • Following adjudication a clinical guideline was drafted by keyHIV Lead clinicians • Clinical guideline presented to and agreed by all London HIV Lead Clinicians • Contract commenced 1st April 2011 • Currently monitoring implementation of clinical guideline

12. Pan London Antiretroviral Therapeutic Tender 2011 – a clinical exercise Projected savings: “Traditional” tender – potentially upto £1m over two years Therapeutic tender - £8m over two years

13. Erythropoesis Stimulating Agents • ESAs are tendered on patient number bandings • Tenders are for product and homecare services • Currently 3 contracts in London • Pan London contract from 1st Jan 2013

14. Erythropoesis Stimulating Agents - short acting tender matrix

15. London ESA Market Share

17. What does the future look like? • Budget constraints - £20 billion savings across the NHS over 3 years • How do we fund patient number growth? • How do we fund high cost drugs? • Therapeutic tendering is a proven model to increase leverage on prices in a branded market • Switching patients will happen where clinically appropriate • True win-wins between NHS and Pharma • Branded Medicines Sub Group of PMSG to manage branded markets nationally

18. Any questions?