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How will the NHS’s new medicines savings drive affect pharma?

Steve How and Sue Thomas, of Wilmington Healthcare, explore how pharma should engage with CCGs on prescribing saving targets
In a bid to cut the NHS’s £16 billion a year drugs expenditure by up to £400m annually, it was recently announced that the NHS will no longer prescribe low value medicines that can be easily bought over-the-counter, such as antihistamines and sun cream.  

NHS Rightcare has been tasked with helping Clinical Commissioning Groups (CCGs) to identify where they are wasting money on sub-optimal healthcare and define how their products and services could be changed in order to improve outcomes and save money.
 

The CCGs will be monitored by four Regional Medicines Optimisation Committees
(RMOCs) which were launched recently to avoid duplication when evaluating medicines, particularly those which are not evaluated by NICE.
 

As NHS budgets tighten and CCGs come under pressure to meet new prescribing targets, the need for pharma to develop strong value propositions for its products has never been greater.   To achieve this, pharma needs to think beyond traditional clinical trial data to provide real world evidence on issues such as how its drugs perform within specific cohorts of patients and their effectiveness over time.  

This kind of real world evidence is becoming increasingly significant as the NHS is now taking advantage of systems such as ‘Eclipse Live’ to identify real world outcomes and compare the effectiveness of one drug against another.
 

With between 30 and 50 percent of long term medicines being taken incorrectly, resulting in huge costs on wasted medicines, concordance programmes should also be a key area of focus for pharma.  

Programmes could include telephone support in the form of nurse helplines as well as the use of monitoring equipment, such as electronically controlled tablet trays that send a signal to a central control centre when a dose is removed from its packaging.
 

The savings that could be generated through improved adherence are so significant that concordance programmes could make cheaper and less powerful medicines more cost-effective for a CCG than expensive rivals that are prescribed without a patient support programme.  

Marrying drugs with CCGs’ prescribing plans
 

As CCGs are forced to make efficiency savings, formulary inclusion is not enough to ensure that a drug will be used. Pharma needs to determine how its value proposition fits into local CCGs’ prescribing plans and create a compelling ‘case for change’ to clinicians.  

Engagement tactics must balance clinicians’ demand for products that show strong clinical benefit and patient safety against medicines management teams’ focus on the cost savings that can be generated by specific products.   Identifying and understanding local NHS strategic priorities is vital.

Pharma must also ascertain CCGs’ QIPP targets and local prescribing efficiency targets,  identifying the potential financial savings that could be made from common QIPP therapy switches.
 

With prescribing incentives being increasingly viewed as a way for CCGs to save money, pharma needs to identify which CCGs participate in such schemes and whether they are for specific products or general formulary adherence. Pharma also needs to know which CCGs offer Gainshare agreements and consider how much value it could offer a CCG or GP practice if it were to enter into such an agreement for a specific drug.  

Although they are frowned on by the Department of Health, Primary Care Rebates are being increasingly used by CCGs to make prescribing budget savings. Data from Wilmington Healthcare from September 2016 showed that the annual CCG income from Rebates nationally was £28.3 million, with 125 CCGs actively engaging in three or more rebates.
 

Knowing which CCGs are likely to accept Primary Care Rebates and determining whether they could prove cost-effective for a product in the long-run is a key factor that pharma needs to consider when creating a local value proposition for a CCG.  

De-prescribing is another issue that is coming to the fore as CCGs seek to save money. While de-prescribing might mean lower sales for pharma, providing a strong value proposition for regular reviews of patients, particularly the elderly and frail, who may no longer be deriving the full benefit of expensive drugs, because of lifestyle or health changes, would enable pharma to engage with the NHS on this agenda.    
 

Thanks to powerful data analytics tools, information on individual CCGs’ priorities and medicines optimisation activities is now easy to obtain. For example, the Medicines Management Dashboard run by Wilmington Healthcare enables pharma account managers to identify a wealth of information on CCGs’ capability to implement prescribing changes, including details of which CCGs run prescribing incentive schemes, or decision support systems and which ones are likely to accept rebates.

In conclusion, the need for pharma to prove the value of its products has never been greater. To achieve this, pharma must fully understand the NHS environment and take a holistic approach underpinned by real world evidence and focussing on cutting costs through improved adherence.  Pharma must also tailor its engagement with CCGs to take account of their local prescribing priorities and challenges, and demonstrate real value on a local as well as national level.
   
                                                                                     
                                                                                    Ends
 

Steve How is Business Development Director and Sue Thomas is CEO of the Commissioning Excellence Directorate, both at Wilmington Healthcare. For information on Wilmington Healthcare, log on to
www.wilmingtonhealthcare.com
   

9th August 2017

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Wilmington Healthcare

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