Contracting of Branded
Medicines
Philip Aubrey
Chair – Branded Medicines Sub Group
of PMSG
PDIG Symposium 10th Nov 2011
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?
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
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
Therapeutic Tendering Matrix
Stakeholder Engagement
PCT
Pharmaceutical
Advisors
Trust
LPP
Pharmacy
Leads
Commissioners
Hospital
Clinicians
/GPs
LPP MUPP
Steering
Group
NHS
CMU
Clinical
Formulary
Pharmacists
Pharmacists
Procurement
Pharmacists
Branded Medicines on Therapeutic
Tenders
•
•
•
•
•
•
•
•
•
•
•
Anti TNFs
Antiretrovirals
Antifungals
Botulinum toxin
Erythropoesis stimulating agents
Fibrinolytics
GCSF
Gonadorelin analogues
Growth Hormone
Hepatitis C
Oral anticoagulants
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
Case Studies
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
Pan London Antiretroviral Therapeutic
Tender 2011 – a clinical exercise
• Following adjudication a clinical guideline was
drafted by key HIV 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
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
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
Erythropoesis Stimulating Agents short acting tender matrix
London ESA Market Share
London ESA Market Shares
Jan 2007 by Patient
Numbers
EPO C
1%
EPO B
53%
London ESA Market Shares
Projected Jan 2012 by
Patient Numbers
EPO E
2%
EPO D
31%
EPO A
46%
EPO A
19%
EPO C
30%
EPO B
18%
London GCSF Market Share Jul 07 to Aug 11
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
DRUG A
DRUG B
DRUG C
DRUG D
DRUG E
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
Any questions?