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Pharmacy & National Pharmacy & National ProcurementProcurement
Christine GilmourChristine GilmourChief Pharmacist NHS LanarkshireChief Pharmacist NHS Lanarkshire
OverviewOverviewBackground
Life before National Procurement
Current Situation
What’s Next?
1
2
3
4
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?
1
2
3
4
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
1
2
3
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?
1
2
3
4
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