Health Service Focus

29.10.19

Utilising biosimilars within the NHS medicines supply chain

Director of the West Essex Integrated Care Partnership, James Roach, alongside Johnny Skillicorn-Aston, comms and engagement lead for Barnet and Enfield CCGs, describe the case for greater uptake of biosimilars within the NHS.

Establishing a firmer position for biosimilars in the medicines supply chain represents a huge opportunity, but is the NHS serious about capitalising on these opportunities?

 A good measure of intent is commercialisation and the recently established Commercial Medicines Directorate within NHS England demonstrates its ambition to achieve maximum value within the increasing spend on medicines.

 The Long Term Plan and 2019 Voluntary Scheme cite biosimilars as a means of driving up competition in the supply chain and producing major savings of up to £300m per year by 2021.

 Over 20 biosimilar drugs are available in the UK and there is a good rate of adoption across the country, although in 2017, one NHS trust in central London had a 25% uptake of biosimilar infliximab, whilst another just 16 miles away achieved an uptake of 99%.

 The uptake of biosimilars to treat autoimmune conditions is strong. However, while the supply chain is developing well with policy and pricing structures in place, to complete the commercial equation, we need to increase demand. The standard ‘push and pull’ marketing approach operates here as it does in other markets and without this the commercial opportunities and savings potential will not be realised.

 Looking at other sectors, there is a useful analogy in the automotive aftermarket industry and the manufacture and supply of non-original replacement car parts. That is, parts with no meaningful difference to those produced by the original car manufacturer but which offer choice; competitive pricing for the consumer; market opportunity for manufacturers, independent service agents and suppliers and which stimulate competition.

 Automotive aftermarket revenue stands at just under £22bn, supports 345,000 jobs and contributes just over £12.2bn to the economy. It creates savings for the consumer by reducing the average annual spend per car and customers are well aware of the marketplace. Both supply-side and demand-side policies combine effectively, with strong relationships between industry and policy-makers. Additionally, engagement with consumers is a key focus for the industry and independent manufacturers, distributors and retailers remain commercially buoyant.

 So, where does this lead? The attainments within the automotive aftermarket have not happened by chance but are the result of lobbying and dialogue that has created a policy and regulatory framework, making things happen. We need a policy and regulatory framework that frees up some of our senior clinical decision-makers to make things happen, not only creating the ‘push’ but also need stimulating the ‘pull’.

 We need greater ambition in how we engage with patients. Ultimately, it is a partnership and we need to be ready and agile enough to align with the ambitions of the LTP and the Voluntary Scheme. We need to make the goals of system-wide savings and better patient access and outcomes just as much our own as those of increasing market share. Biosimilars are the ‘win-win’ where we can create the space to test, diagnose and treat more people; all achieved in an NHS environment that is cash-strapped. Because there is no new money, it is critical that we maximise the opportunity of biosimilars.

It is about engaging with impact and making biosimilars relevant to a changing NHS, capitalising on the opportunities for biologics. Medicines management, which from 2021 will operate at an Integrated Care System (ICS) level, is a real opportunity.

 There will be 44 ICSs across the NHS through which we can bring influence at a strategic level to secure the uptake of biosimilars at a regional scale. It also means there will be fewer people to interact with; getting a seat at the table but going through fewer doors.

 At a local level, primary care networks represent further supply chain opportunities. It is a space ripe for optimisation, switching and patient engagement. Prescribing is still clunky and old-fashioned but modalities like electronic prescribing are the prospects for change. Engaging with patients on options that suit their lifestyles and put them in control, creates shared responsibility that supports choice and develops the ‘pull’ in the market.

 What do we need from pharma as it adjusts to operating within the LTP and the Voluntary Scheme? Pharma needs to secure access by leading with evidence of impact, making the industry relevant to the whole health economy. Whether at a population health or local level, pharma must get buy-in and its data can stimulate and manage dialogue with both decision-makers and patients. The intelligent use of data will highlight the need to address upturn in demand, work harder to secure better outcomes and reduce health inequalities.

This does not mean more work, rather it will generate more powerful long-term benefits for patients and the health care system. Pharma can play a central role in supporting and reinforcing dialogue between health professionals and patients. The UK is unique in its relationship between patients and healthcare professionals, and pharma needs to be part of that. There are openings for engaging in ways more relevant to a changing NHS.

 The NHS is about transformation and innovation. However, the received view of innovation is that it is all about procedures and devices. Pharma needs to address this because medicines are the big game changer and the industry can do more to secure its place along the transformational trajectory.

 The pharma industry, its research and development work and access to life-changing, innovative drugs is well-felt within society. From antibiotics, NSAIDs and hormonal drugs to antiretrovirals, antimalarials and contraceptives, the lives of countless people have been changed. Drugs are at the forefront of innovation and transformation.

 In terms of prevalence, we need to be clear on the cost of this and biosimilars can address this to achieve the desired savings potential. Working with health systems, clinicians and patients to optimise therapies and medication will make a difference. Reducing need in the patient pathway and managing complexity differently requires the industry to be ambitious, confident and self-assured.

There might be a degree of reluctance but there is a new clinical dialogue to be had and the time is right for it. The traditional NHS/pharma relationship is changing and biosimilars can drive it in new directions. The evidence is there in the fact that the product is already approved.

 Biosimilars bring many opportunities and conversation now needs to look at mutuality. We can align with the NHS ambition and seek a share of the investment, however, the focus needs to fall beyond that.

 The critical point is how we maximise the benefits coming out of the new strategy. The new Medicines Directorate signals a growing commercial appetite but it is about how the benefits are reinvested. Not just reinvesting in front-line care but also in those companies that have taken the risk, have resourced a product and have invested accordingly.

 The risk and gain share has to be mutual and it is time for the industry to lead the conversation with the NHS about how we share the gain over the lifetime of the LTP. Biosimilars are the ‘starter-for-ten’.

Infection Prevention

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