Pharmacy & National Procurement Christine Gilmour Chief Pharmacist NHS Lanarkshire

Pharmacy & National Pharmacy & National ProcurementProcurement

Christine GilmourChristine GilmourChief Pharmacist NHS LanarkshireChief Pharmacist NHS Lanarkshire

OverviewOverviewBackground

Life before National Procurement

Current Situation

What’s Next?

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OverviewOverviewBackground

Life before National Procurement

Current Situation

What’s Next?

1

2

3

4

Principles of Medicine PurchasingPrinciples of Medicine Purchasing((in the managed service)in the managed service)

Pharmacy = single purchase pointPharmacy = single purchase point Pharmacy decides what to buyPharmacy decides what to buy No non-stockNo non-stock Purchase order every time Purchase order every time

MedicinesMedicines

GenericGeneric <<20% of spend20% of spend

Patent ExpiredPatent Expired

Multiple suppliersMultiple suppliers

Ability to tenderAbility to tender

BrandedBranded >80% of spend>80% of spend

Patent protectedPatent protected

Single supplierSingle supplier

No dealNo deal

Primary Care Primary Care

Bulk of NHS medicine spend is in primary careBulk of NHS medicine spend is in primary care

Generic drug prices controlled via Drug TariffGeneric drug prices controlled via Drug Tariff

Medicines are sourced and purchased by the Medicines are sourced and purchased by the community pharmacy contractor who is then community pharmacy contractor who is then reimbursed at tariff or list price. NHS does not reimbursed at tariff or list price. NHS does not buy the medicines. buy the medicines.

Branded MedicinesBranded Medicines

Branded medicines = ~80% of the NHS drug spend Branded medicines = ~80% of the NHS drug spend Prices of branded medicines are controlled by the Prices of branded medicines are controlled by the

Pharmaceutical Price Regulation Scheme (PPRS).Pharmaceutical Price Regulation Scheme (PPRS). Therapeutic tendering has been challengedTherapeutic tendering has been challenged

Pharmaceutical Price Regulation Scheme Pharmaceutical Price Regulation Scheme (PPRS)(PPRS)

Is a reserved matter negotiated by DoH Is a reserved matter negotiated by DoH Is a voluntary agreementIs a voluntary agreement Regulates UK market for branded medicines. Regulates UK market for branded medicines. Allows manufacturers to make a capped level of profit Allows manufacturers to make a capped level of profit

in relation to their investment.in relation to their investment. Manufacturers are able to modulate prices across a Manufacturers are able to modulate prices across a

product rangeproduct range

OverviewOverviewBackground

Life before National Procurement

Current Situation

What’s Next?

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2

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Pre-National ProcurementPre-National Procurement

National Contracts facilitated via CSA. National Contracts facilitated via CSA. Contracts award = 1 meeting of a pharmacy Contracts award = 1 meeting of a pharmacy

panelpanel Good compliance with contractsGood compliance with contracts Hospital loss leaders Hospital loss leaders White Pages and Blue PagesWhite Pages and Blue Pages Local deals and bulk contractsLocal deals and bulk contracts

OverviewOverviewBackground

Life before National Procurement

Current Situation

What’s Next

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4

Current SituationCurrent Situation Procurement Procurement ShortagesShortages Patient Access SchemesPatient Access Schemes Medicine Homecare ServicesMedicine Homecare Services Access to Medicines in Primary CareAccess to Medicines in Primary Care Few, if any, local deals – no bulk purchasesFew, if any, local deals – no bulk purchases

* * Governance Framework Governance Framework **

Pharmacy Team within NPPharmacy Team within NP

Pharmacy Procurement Governace Framework

Clinical Advisory PanelsClinical Advisory PanelsActions on 2014/15 Work Plan

• NES Online Training module for CAP panel members.

• Re-fresh of medicine CAP panel membership.

• Ensuring pharmacy representation on relevant non-medicines CAPs.

• Scoping joint working with England on QA checks (use of the Pharma QC system) to reduce the workload burden on Scottish QA Pharmacists.

Medicine Homecare ServicesMedicine Homecare Services

Low tech

Patient self-administration Oral medicines (excluding oral oncology) or external use Licensed medicines, uncomplicated devices. No complex storage requirements

Mid tech

Patient training or competency assessment required Significant clinical support or diagnostic testing (inc oral oncology) Unlicensed medicines , medicines with special storage requirements

High tech IV infusion Compounded aseptic medicines.

Complex

Bespoke homecare solutions Permanent or semi-permanent adaption of home environment Clinical responsibility delegated to third party

Definitions:

OverviewOverviewBackground

Life before National Procurement

Current Situation

What’s Next?

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Whole New Agenda!Whole New Agenda!

ShortagesShortages Patient Access SchemesPatient Access Schemes Access to Medicines in Primary CareAccess to Medicines in Primary Care Medicine Homecare ServicesMedicine Homecare Services Complex discount schemesComplex discount schemes Biosimilar medicinesBiosimilar medicines European Medicines Verification System European Medicines Verification System Managing SuppliersManaging Suppliers Optimising efficiency of procurement & supply Optimising efficiency of procurement & supply

chain chain

ShortagesShortages Patient Access SchemesPatient Access Schemes Access to Medicines in Primary CareAccess to Medicines in Primary Care Medicine Homecare ServicesMedicine Homecare Services Complex discount schemesComplex discount schemes Biosimilar medicinesBiosimilar medicines European Medicines Verification System European Medicines Verification System Managing SuppliersManaging Suppliers Optimising efficiency of procurement & supply Optimising efficiency of procurement & supply

chain chain

Access to Medicines in Primary CareAccess to Medicines in Primary Care

Issue Manufacturer refusal to supply community pharmacies

Manufacturers using discounting to put in place financial disincentives to use community pharmacies e.g .via PAS schemes

Cause Predominantly Parallel Trade

Manufacturers inability to control use of stock purchased by community pharmacies

ShortagesShortages Patient Access SchemesPatient Access Schemes Access to Medicines in Primary CareAccess to Medicines in Primary Care Medicine Homecare ServicesMedicine Homecare Services Complex discount schemesComplex discount schemes Biosimilar medicinesBiosimilar medicines European Medicines Verification System European Medicines Verification System Managing SuppliersManaging Suppliers Optimising efficiency of procurement & supply Optimising efficiency of procurement & supply

chain chain

Complex DiscountsComplex Discounts

Not business as usualNot business as usual Each is uniqueEach is unique Usually involve individual patient trackingUsually involve individual patient tracking Need to ensure they do not dictate patient Need to ensure they do not dictate patient

pathways of care. pathways of care.

ShortagesShortages Patient Access SchemesPatient Access Schemes Access to Medicines in Primary CareAccess to Medicines in Primary Care Medicine Homecare ServicesMedicine Homecare Services Complex discount schemesComplex discount schemes Biosimilar medicinesBiosimilar medicines European Medicines Verification System European Medicines Verification System Managing SuppliersManaging Suppliers Optimising efficiency of procurement & supply Optimising efficiency of procurement & supply

chain chain

Biologics & BiosimilarsBiologics & Biosimilars

Expensive to research, develop, manufacture and bring to the Expensive to research, develop, manufacture and bring to the market – hence the very high prices charged. market – hence the very high prices charged.

The same molecule manufactured by another company is known The same molecule manufactured by another company is known as a biosimilar as a biosimilar

Much debate as to whether patients can or should be switched Much debate as to whether patients can or should be switched from one biosimilar to another. from one biosimilar to another.

Biosimilars are just emerging on to the marketBiosimilars are just emerging on to the market

ShortagesShortages Patient Access SchemesPatient Access Schemes Access to Medicines in Primary CareAccess to Medicines in Primary Care Medicine Homecare ServicesMedicine Homecare Services Complex discount schemesComplex discount schemes Biosimilar medicinesBiosimilar medicines European Medicines Verification System European Medicines Verification System Managing SuppliersManaging Suppliers Optimising efficiency of procurement & supply Optimising efficiency of procurement & supply

chain chain

European Medicines Verification System