Update from the ABPI
Procurement and Distribution
Interest Group
6 November 2014
Carol Blount NHS Partnerships Director
PPRS context
Since the 1950s, PPRS has been negotiated between Department of Health
(DH) on behalf of all 4 nations and the ABPI, on behalf of the UK researchbased industry
• For DH as the primary negotiator on medicines in the UK, DH needs to ensure
medicines are available at reasonable prices whilst the environment remains
positive for the biopharmaceutical industry
• For Industry, the scheme recognises the need to ensure patients have access to
the medicines they need and that the Industry remains profitable to enable on
going investment in research and development
2
2014 PPRS Context
At the time of negotiation of PPRS, both sides recognised the challenge
UK austerity, debt and
rising healthcare costs
Low and slow uptake of
newer medicines, but
lowest prices in Europe
Importance of life
sciences industry and
R&D to the UK economy
Stability required for the
longer term for both
industry and Government
3
Understanding the PPRS
Previous PPRS have featured price
cuts, so NHS benefits from
lower prices but spend
increased
The 2014 scheme underwrites the
overall growth in spend by the
NHS on branded medicines
within the scheme
 Industry is a committed partner with NHS across the UK
 Supports patients and clinicians access to newer medicines
 Five-year agreement covering 2014-2018
 Commitments to dialogue on NICE and uptake
 Vast majority (90%+) of branded medicines included in the scheme
4
Majority of Branded products are in PPRS
PPRS includes 93% of UK branded medicines by value (Jan 2014 data):
98% of all Branded medicines
spend in Primary Care
87% of Branded medicines
spend in Secondary Care
It doesn’t include..
• Exceptional central procurements (national stockpiles, pandemic preparation)
• Procurements of centrally supplied vaccines
• Parallel imports or exports
5
New five year pricing agreement caps the
medicines bill for the first time
The deal
Estimated
payments
c£4b
“This agreement ensures NHS patients will receive the best and most advanced medicines in the world
while managing the cost. UK pharmaceutical companies have responded to the challenges we face as
a country, both in terms of the increased demand for medicines and pressure on public spending.”
Jeremy Hunt, Health Secretary, Department of Health press release, 6th November 2013
6
Q2 data published by DH
Q2 Payment: £76M, YTD Growth: 5.52%
£000's
Q1 2013
Q2 2013
Q3 2013
Q4 2013
Q1 2014
Q2 2014
Growth
Aggregate Net Sales Subject to
Medicines Bill Growth Calculation
(Measured Spend)
1,865,113
1,943,105
2,012,318
2,151,675
1,985,170
2,033,106
Aggregate Net Sales
Covered by the PPRS
payment
1,865,113
1,943,105
2,012,318
2,151,675
1,982,636
2,024,576
Aggregate
Payment
received by DH
74,000
76,000
YTD Q1
1,865,113
1,985,170
6.44%
New products launched after the
start of the scheme account for
0.275% of measured spend YTD,
vs forecast of 0.47%.
YTD Q2
3,808,218
4,018,276
5.52%
Q2 alone
4.63%
7
PPRS Forecast and payments
2014
2015
2016
2017
2018
Initial forecast Growth Rate of
Measured Spend (F%)
3.87%
3.52%
3.86%
2.14%
3.09%
Allowed Growth Rate of Measured
Spend (AGR)
0%
0%
1.8%
1.8%
1.9%
Initial forecast of New Products
Share of Measured Spend (NP%)
0.47%
1.85%
3.37%
5.13%
7.01%
Initial annual payment percentage
(P%1)
3.74%
7.13%
9.92%
9.92%
9.92%
Estimated future annual payment
percentages (2015-2018) (FP%2,
FP%3, FP%4, FP%5)
8
2015
2014
Timelines:
30 Apr 14
2014 Q1 Sales Report + Payment
18 June 14
Q1 data published
31 July 14
2014 Q2 Sales Report + Payment
12 Sept 14
Q2 data published
31 Oct 14
2014 Q3 Sales Report + Payment
Early Dec 14
Q3 data published + 2015 % Payment set & communicated
31 Jan 15
2014 Q4 Sales Report + Payment
30 Apr 15
2015 Q1 Sales Report + Payment
31 July 15
2015 Q2 Sales Report+ Payment
30 Sept 15
2014 Annual Sales Report submitted
31 Oct 15
2015 Q3 Sales Report + Payment
Nov 15
2016 % Payment set & communicated
9
NHS communication on PPRS:
“The NHS and pharmaceutical industry
have a mutual interest to ensure
patients can access cost and clinically
effective innovative medicines and can
optimise the use of these medicines to
achieve better outcomes”
“NHS England, DH and the ABPI are
continuing to work collaboratively to
ensure that the NHS maximises the
opportunities offered by the
Agreement”
10
Industry and NHS England partnership
What is industry doing?
 Committed to improving access for
patients across the UK through this
deal and through negotiated access
schemes
 Significant payments made, industry
commitment to the NHS
 New joint NHS England /ABPI
PPRS/Medicines Optimisation
programme to drive change
 Supporting Innovation, Health and
Wealth
Unanswered questions
•
•
•
•
Could PPRS payments go directly to
commissioners / budget holders to
support uptake of new medicines?
How can PPRS encourage an end to
rationing of innovative medicines?
How to improve transparency and
accountability on the use of new
medicines via one set of metrics?
How to focus on value and outcomes,
not on short term costs alone
11
PPRS provides a one-off opportunity
Patients and clinicians the PPRS provides an opportunity to find the right
level of usage of branded medicines, based on clinical factors rather than cost
For the NHS, medicines bill growth has been underwritten, so commissioners
can remove barriers to clinicians choosing which medicines to use
For industry: PPRS gives a level of stability and supports innovative
companies, but need to change access and uptake of innovative medicines
For Government and the taxpayer: PPRS achieves predictability on the
branded medicines bill through this period
12
PPRS/Medicines Optimisation programme
ABPI: NHSE joint programme aims:
1. To improve patient outcomes, quality and value of care from medicines use
2. To maximise the benefits of the PPRS through a joint programme of action
3. To accelerate uptake of innovative, clinically effective and cost effective medicines
4. To create clinical pull for patient access to these medicines
Medicines optimisation
MO dashboard joint venture,
patient panel
Access and uptake of innovation
including IHW commitments , a
combined national metrics report,
Pilot of 90 day tariff
Specialised commissioning
Impact of MO on specialised
commissioning, joint work on
Commissioning through Evaluation
Communications and engagement
NHSE/ABPI regional road shows,
joint communications, ABPI Therapy
Groups working with NCDs
Governance: PPRS/MO steering group: NHSE, ABPI, AHSNs, RPS, RCN, CCGs,
BGMA, DH
13
Medicines Optimisation Guidance
Medicines Optimisation – intended outcomes
Principle 1
Aim to understand the patient’s experience
 Patients are more engaged, understand more about their medicines and are able to make choices,
including choices about prevention and healthy living
 Patients’ beliefs and preferences about medicines are understood to enable a shared decision about
treatment
 Patients are able to take/use their medicines as agreed
 Patients feel confident enough to share openly their experiences of taking or not taking medicines,
their views about what medicines mean to them, and how medicines impact on their daily life
Principle 2
Evidence based choice of medicines



Optimal patient outcomes are obtained from choosing a medicine using best evidence (for example,
following NICE guidance, local formularies etc) and these outcomes are measured
Treatments of limited clinical value are not used and medicines no longer required are stopped
Decisions about access to medicines are transparent and ain accordance with the NHS Constitution
Medicines Optimisation – intended outcomes
Principle 3
Ensure Medicines use is as safe as possible






Incidents of avoidable harm from medicines are reduced
Patients have more confidence in taking their medicines
Patients feel able to ask healthcare professionals when they have a query or difficulty with their
medicines
Patients remain well and there is a deduction in admissions and readmissions to hospitals related
to medicines usage
Patients discuss potential side-effects are there is an increase in reporting to the Medicines and
Healthcare products Regulatory Agency (MHRA)
Patients take unused medicines to community pharmacies for safe disposal
Principle 4
Make medicines optimisation part of routine practice
 Patients feel able to discuss and review their medicines with anyone involved in their care
 Patients receive consistent messages about medicines because the healthcare team liaise
effectively
 It becomes routine practice to signpost patients to further help with their medicines wand to local
patient support groups
 Inter-professional and inter-agency communication about patients’ medicines is improved
 Medicines wastage is reduced
 The NHS achieves greater value for money invested in medicines
 The impact of medicines optimisation is routinely measured.
ABPI Regional Partnership Managers
Team
• 4 Regional Partnership Managers aligned to the 4 regions in England
• Harriet Lewis (North); Andy Riley (Midlands and East); Hasseena Winter (London)
• Diana Vegh (South)
RPM Purpose:
•To be the regional face of Industry and position Industry as a partner to the NHS and an integral
part of the solution
•Responsible for shaping and improving the regional environment for Industry, to improve patient
outcomes by enabling patient access to and optimum usage of innovative medicines
•Develop and establish strong, sustainable relationships with key regional NHS stakeholders
and member companies
RPM Primary focus 2015 :
Implementation of nationally agreed policies at a regional level (eg IHW, MO)
Delivery of the joint PPRS/Medicines optimisation programme at a regional level to:
•
•
•
•
Improve patient outcomes, quality and value of care from appropriate medicines use
Maximise the benefits of the new PPRS scheme through a joint programme of action
Accelerate uptake of clinically effective and cost effective branded medicines
Create clinical pull for patient access to these medicines
Current Industry : AHSN Medicines Optimisation collaborations
NHS Organisation
description
NENC AHSN
communication transfer at interface, medicines
review in care homes /improve use of Respiratory
COPD medicines
Projected Outcomes / Measures of Success
Reduction of medication errors for vulnerable patients
Improved outcomes for patients with respiratory
conditions
NENC AHSN
Programme of work led by NE Quality Observatory.
adoption of NICE TAs without barriers
Y&H AHSN
Diabetes care pathway review
adoption of NICE TAs
Y&H AHSN
Anticoagulation service redesign
improved anticoagulation provision and access to
appropriate medicines in accordance with NICE
GMAHSN
Adoption of integrated framework for rapid and
effective implementation of NICE TAs
Validation and roll out of framework developed by Oldham
CCG
Oxford AHSN
Stroke prevention/ adoption of NICE guidance for
NOACs
To work with IMS on using the most effective treatment for
patients with AF and change prescribing behaviour
Southampton FT/
Wessex AHSN
Reducing harm from alcohol
Linking clinical services and commissioners to reduce
alcohol related harm
WM AHSN
Flo tele-health – including adherence support
package
STARTBACK – stratified care model for back pain
Improvements in patient adherence to medicines
Eastern AHSN
(PRESCQIPP)
Build MO programme and IHW work streams
Insights into factors which contribute to medicines waste
and what can be done to improve adherence and
enhance treatment outcome
Nottingham Uni
Roll out of PINCER across all the practices in East
Rushcliff CCG / EM Midlands
AHSN
working in partnership with the steering group at East
Midlands AHSN and support the development of 18
medicines safety infra-structure in primary care
Innovation Health and Wealth
“NHS England is committed to delivering the recommendations in the Innovation,
Health and Wealth Report to improve outcomes for individuals, carers and families”
NHS Mandate chapter 7 ‘The broader role of the NHS in society’
“NHS England is committed to ongoing implementation of IHW, which seeks to improve
NHS use of innovative treatments for the benefit of patients..”
PPRS 2014 chapter 4
The overall expectation is that the IHW refresh would continue to build the strategic
direction , update progress and set out next steps, supported by a series of actions and
timelines for the next 2-3 years as the next stage in the longer term strategy.
Innovation Health and Wealth Refresh
Industry proposals
1.Reducing variation and strengthening compliance – continued commitment to the NICE
compliance regime
•Rapid and consistent implementation of NICE TAs
•NICE TA recommendations are incorporated automatically included into relevant local NHS
formularies and formularies are published
•Continued commitment to and resourcing of the NICE Implementation Collaborative to
overcome system wide barriers to implementation of NICE TAs
•Development of the Innovation Scorecard into the new combined metrics report
2.AHSNs – continued commitment to fund AHSNs and greater clarity in their role in improving
the adoption of innovative medicines is needed
3.Aligning financial , operational and performance incentives – financial incentives should work
to encourage early adoption of NICE TAs.
•Introduction of an integrated national incentive for improved access and uptake of NICE TAs
with sanctions/penalties for organisations found to be blocking or restricting patient access to
those medicines.
•Align existing incentive schemes
•Regular audit of NICE TA implementation and publication of annual Innovation Returns at
organisational level
•Include IHW as a national priority for inclusion in Quality accounts
Innovation Health and Wealth Refresh
Industry proposals
4.Increasing responsibility and accountability for IHW from national to local level within the
NHS
•NHS clinical, operational and financial accountability for IHW delivery needs to be
considerably strengthened, from the NHSE Board , through the operational directorate to local
levels
•Innovation plans and objectives should be set at every level and audited
•The IHW Implementation Board should be reconstituted and reinstated including senior level
representation of NHSE clinical , operations and finance