NHS England has unveiled its plan to completely eliminate hepatitis C, signing up three pharma companies to the £1bn ($1.29bn) programme which involves identifying and curing patients with drug treatments.
Gilead Sciences, Merck Sharp and Dohme (MSD) and AbbVie have signed up to the first-of-its-kind three year deal, with NHS England proudly proclaiming its success in driving down the cost of the hepatitis C (HCV) medicines using its tendering process.
NHS England’s chief executive Simon Stevens has praised his organisation’s “sophisticated and unashamedly rigorous negotiation” for securing a good deal for patients and taxpayers by driving a hard bargain with the three rival firms.
The plans were first announced last year, when NHSE called on the pharma companies to cut their hepatitis C drug prices in return for a slice of the three year supply contract, which could be extended to five years.
However, it ran into trouble when AbbVie mounted a legal action against NHSE, accusing it of of not treating all bidders fairly. The resulting High Court case ended triumphantly for NHSE however, which saw the judge ruling in its favour.
Now the results are out, and NHS England has gone as far as giving the three bidders ‘medal status’: Gilead has been awarded ‘gold’, MSD ‘silver’ and AbbVie, ‘bronze’.
A spokesman for NHS England told PME that these rankings reflect the value for money offered by the tender offered by each company, including the cost of drug treatment as well as the proposed programmes to identify the many thousand of as-yet undiagnosed people with hepatitis C in England.
The deal reflects NHS England’s growing control over market access for specialised medicines in England, and it’s thought that it has succeeded in driving down the costs of the drug from £35,000 to just £10,000 per patient.
The programme will include two Gilead hep C drugs at discounted prices: Harvoni and Epclusa, the latter being a ‘universal’ treatment for all HCV subtypes, including the more hard-to-treat genotypes.
Hilary Hutton-Squire, General Manager Gilead UK and Ireland, said: “[The deal will] allow us to continue to play a critical role together with our partners, in delivering patient finding support programmes. Gilead Sciences shares NHS England’s commitment to eliminate the virus through a broad public health strategy that will enable all individuals living with hepatitis C to be cured of this life-threatening disease.”
Taking silver status is MSD, which came late to market with its HCV treatment, Zepatier, and has sought to undercut Gilead and AbbVie in global markets in order to seize market share.
Meanwhile AbbVie, which has claimed the bronze status, will supply its pan-genotypic regimen Maviret as well as Viekirax and Exviera. The spokesman for NHS England denied that the legal challenge had influenced its decision-making at all, and said the tenders were awarded on value for money and the patient identification programmes.
NHS England has said, however, that the legal action delayed its plans by six months, and is now reluctant to put a date on when it might achieve full eradication of the disease. It had previously identified 2025 as a goal, but says it remains confident of being one of the first countries to achieve this status, and well ahead of the WHO’s 2030 global goal.
The three pharma companies will all launch programmes in collaboration with local health services, councils and voluntary groups to establish 22 ‘operational delivery networks’ to find potential patients, test for infection and provide treatment to those who need it.
This will help improve uptake in areas that have historically low service provision, with local teams using the National Hepatitis C patient registry to record and monitor treatment uptake.
“The new procurement allows us to prescribe all of the available treatments for hepatitis C and the increased focus on case finding will allow us to expand services to the most vulnerable in our society,” said professor Graham Foster, national clinical chair for hepatitis C, NHS England.
The deal was negotiated by the Commercial Medicines Unit, NHS England’s dedicated procurement team headed up by Blake Dark, commercial Director of Specialised Medicines of NHS England.
Simon Stevens, chief executive of NHS England, who said: “It’s not often that the opportunity arises to completely eradicate a disease, but now the NHS is taking practical action to achieve exactly that.
“The NHS’s sophisticated and unashamedly rigorous negotiation on behalf of both patients and taxpayers means we’ve now been able to strike affordable deals with our life sciences partners to save many more lives and meaningfully cut health inequalities.”
Over 30,000 people in England have already benefited from from the HCV treatments since Gilead launched the first, Sovaldi, in Europe in 2014. However there remain an estimated 113,000 people living in England still infected with the virus.
Rachel Halford, chief executive of The Hepatitis C Trust, said: “The Hepatitis C Trust is delighted with this development. 69% of people who have the virus are currently undiagnosed so the funding in the deal to help find those with hepatitis C and support them into treatment is groundbreaking.
“We believe this deal offers a unique opportunity for all stakeholders – patient organisations, pharmaceutical companies, clinicians, prison healthcare and drug misuse services – to work together to reach all those affected.”
The deal reflects a trend across all developed markets, whereby the HCV competitors, most especially Gilead, earn billions from treating the most easy-to-identify and treat patients. However sales of the drugs have dropped off dramatically as finding the remaining patients with HCV, which can remain symptomless for decades, has proven far more difficult.