1. Update from the ABPI Procurement and Distribution Interest Group 6 November 2014 Carol Blount NHS Partnerships Director

2. PPRS context
Since the 1950s, PPRS has been negotiated between Department of Health (DH) on behalf of all 4 nations and the ABPI, on behalf of the UK research- based industry
For DH as the primary negotiator on medicines in the UK, DH needs to ensure medicines are available at reasonable prices whilst the environment remains positive for the biopharmaceutical industry
For Industry, the scheme recognises the need to ensure patients have access to the medicines they need and that the Industry remains profitable to enable on going investment in research and development

3. 2014 PPRS Context
At the time of negotiation of PPRS, both sides recognised the challenge
UK austerity, debt and rising healthcare costs
Low and slow uptake of newer medicines, but lowest prices in Europe
Importance of life sciences industry and R&D to the UK economy
Stability required for the longer term for both industry and Government

4. Understanding the PPRS
Previous PPRS have featured price cuts, so NHS benefits from lower prices but spend increased
The 2014 scheme underwrites the overall growth in spend by the NHS on branded medicines within the scheme
Industry is a committed partner with NHS across the UK
Supports patients and clinicians access to newer medicines
Five-year agreement covering
Commitments to dialogue on NICE and uptake
Vast majority (90%+) of branded medicines included in the scheme

5. Majority of Branded products are in PPRS
PPRS includes 93% of UK branded medicines by value (Jan 2014 data):
It doesn’t include..
Exceptional central procurements (national stockpiles, pandemic preparation)
Procurements of centrally supplied vaccines
Parallel imports or exports
98% of all Branded medicines spend in Primary Care
87% of Branded medicines spend in Secondary Care 5

6. New five year pricing agreement caps the medicines bill for the first time
The deal
Estimated payments
c£4b
“This agreement ensures NHS patients will receive the best and most advanced medicines in the world while managing the cost. UK pharmaceutical companies have responded to the challenges we face as a country, both in terms of the increased demand for medicines and pressure on public spending.”
Jeremy Hunt, Health Secretary, Department of Health press release, 6th November 2013

7. Q2 Payment: £76M, YTD Growth: 5.52%
Q2 data published by DH
Q2 Payment: £76M, YTD Growth: 5.52%
New products launched after the start of the scheme account for 0.275% of measured spend YTD, vs forecast of 0.47%.
Q2 alone 4.63%

8. PPRS Forecast and payments

9. Timelines:
2014
30 Apr 14
2014 Q1 Sales Report + Payment
18 June 14
Q1 data published
31 July 14
2014 Q2 Sales Report + Payment
12 Sept 14
Q2 data published
31 Oct 14
2014 Q3 Sales Report + Payment
Early Dec 14
Q3 data published % Payment set & communicated
2015
31 Jan 15
2014 Q4 Sales Report + Payment
30 Apr 15
2015 Q1 Sales Report + Payment
31 July 15
2015 Q2 Sales Report+ Payment
30 Sept 15
2014 Annual Sales Report submitted
31 Oct 15
2015 Q3 Sales Report + Payment
Nov 15
2016 % Payment set & communicated

10. NHS communication on PPRS:
“The NHS and pharmaceutical industry have a mutual interest to ensure patients can access cost and clinically effective innovative medicines and can optimise the use of these medicines to achieve better outcomes”
“NHS England, DH and the ABPI are continuing to work collaboratively to ensure that the NHS maximises the opportunities offered by the Agreement”

11. Industry and NHS England partnership
What is industry doing?
Could PPRS payments go directly to commissioners / budget holders to support uptake of new medicines?
How can PPRS encourage an end to rationing of innovative medicines?
How to improve transparency and accountability on the use of new medicines via one set of metrics?
How to focus on value and outcomes, not on short term costs alone
Unanswered questions
Committed to improving access for patients across the UK through this deal and through negotiated access schemes
Significant payments made, industry commitment to the NHS
New joint NHS England /ABPI PPRS/Medicines Optimisation programme to drive change
Supporting Innovation, Health and Wealth

12. PPRS provides a one-off opportunity
Patients and clinicians the PPRS provides an opportunity to find the right level of usage of branded medicines, based on clinical factors rather than cost
For the NHS, medicines bill growth has been underwritten, so commissioners can remove barriers to clinicians choosing which medicines to use
For industry: PPRS gives a level of stability and supports innovative companies, but need to change access and uptake of innovative medicines
For Government and the taxpayer: PPRS achieves predictability on the branded medicines bill through this period

13. PPRS/Medicines Optimisation programme
ABPI: NHSE joint programme aims:
To improve patient outcomes, quality and value of care from medicines use
To maximise the benefits of the PPRS through a joint programme of action
To accelerate uptake of innovative, clinically effective and cost effective medicines
To create clinical pull for patient access to these medicines
Medicines optimisation
MO dashboard joint venture, patient panel
Access and uptake of innovation
including IHW commitments , a combined national metrics report,
Pilot of 90 day tariff
Specialised commissioning
Impact of MO on specialised commissioning, joint work on Commissioning through Evaluation
Communications and engagement
NHSE/ABPI regional road shows, joint communications, ABPI Therapy Groups working with NCDs
Governance: PPRS/MO steering group: NHSE, ABPI, AHSNs, RPS, RCN, CCGs, BGMA, DH

14. Medicines Optimisation Guidance

15. Medicines Optimisation – intended outcomes
Principle 1
Aim to understand the patient’s experience
Patients are more engaged, understand more about their medicines and are able to make choices, including choices about prevention and healthy living
Patients’ beliefs and preferences about medicines are understood to enable a shared decision about treatment
Patients are able to take/use their medicines as agreed
Patients feel confident enough to share openly their experiences of taking or not taking medicines, their views about what medicines mean to them, and how medicines impact on their daily life
Principle 2
Evidence based choice of medicines
Optimal patient outcomes are obtained from choosing a medicine using best evidence (for example, following NICE guidance, local formularies etc) and these outcomes are measured
Treatments of limited clinical value are not used and medicines no longer required are stopped
Decisions about access to medicines are transparent and ain accordance with the NHS Constitution

16. Medicines Optimisation – intended outcomes
Principle 3
Ensure Medicines use is as safe as possible
Incidents of avoidable harm from medicines are reduced
Patients have more confidence in taking their medicines
Patients feel able to ask healthcare professionals when they have a query or difficulty with their medicines
Patients remain well and there is a deduction in admissions and readmissions to hospitals related to medicines usage
Patients discuss potential side-effects are there is an increase in reporting to the Medicines and Healthcare products Regulatory Agency (MHRA)
Patients take unused medicines to community pharmacies for safe disposal
Principle 4
Make medicines optimisation part of routine practice
Patients feel able to discuss and review their medicines with anyone involved in their care
Patients receive consistent messages about medicines because the healthcare team liaise effectively
It becomes routine practice to signpost patients to further help with their medicines wand to local patient support groups
Inter-professional and inter-agency communication about patients’ medicines is improved
Medicines wastage is reduced
The NHS achieves greater value for money invested in medicines
The impact of medicines optimisation is routinely measured.

17. ABPI Regional Partnership Managers
Team
4 Regional Partnership Managers aligned to the 4 regions in England
Harriet Lewis (North); Andy Riley (Midlands and East); Hasseena Winter (London)
Diana Vegh (South)
RPM Purpose:
•To be the regional face of Industry and position Industry as a partner to the NHS and an integral part of the solution
•Responsible for shaping and improving the regional environment for Industry, to improve patient outcomes by enabling patient access to and optimum usage of innovative medicines
•Develop and establish strong, sustainable relationships with key regional NHS stakeholders and member companies
RPM Primary focus 2015 :
Implementation of nationally agreed policies at a regional level (eg IHW, MO)
Delivery of the joint PPRS/Medicines optimisation programme at a regional level to:
Improve patient outcomes, quality and value of care from appropriate medicines use
Maximise the benefits of the new PPRS scheme through a joint programme of action
Accelerate uptake of clinically effective and cost effective branded medicines
Create clinical pull for patient access to these medicines

18. Projected Outcomes / Measures of Success
Current Industry : AHSN Medicines Optimisation collaborations
NHS Organisation
description
Projected Outcomes / Measures of Success
NENC AHSN
communication transfer at interface, medicines review in care homes /improve use of Respiratory COPD medicines
Reduction of medication errors for vulnerable patients
Improved outcomes for patients with respiratory conditions
Programme of work led by NE Quality Observatory.
adoption of NICE TAs without barriers
Y&H AHSN
Diabetes care pathway review
adoption of NICE TAs
Anticoagulation service redesign
improved anticoagulation provision and access to appropriate medicines in accordance with NICE
GMAHSN
Adoption of integrated framework for rapid and effective implementation of NICE TAs
Validation and roll out of framework developed by Oldham CCG
Oxford AHSN
Stroke prevention/ adoption of NICE guidance for NOACs
To work with IMS on using the most effective treatment for patients with AF and change prescribing behaviour
Southampton FT/ Wessex AHSN
Reducing harm from alcohol
Linking clinical services and commissioners to reduce alcohol related harm
WM AHSN
Flo tele-health – including adherence support package
STARTBACK – stratified care model for back pain
Improvements in patient adherence to medicines
Eastern AHSN (PRESCQIPP)
Build MO programme and IHW work streams
Insights into factors which contribute to medicines waste and what can be done to improve adherence and enhance treatment outcome
Nottingham Uni Rushcliff CCG / EM AHSN
Roll out of PINCER across all the practices in East Midlands
working in partnership with the steering group at East Midlands AHSN and support the development of medicines safety infra-structure in primary care

19. Innovation Health and Wealth
“NHS England is committed to delivering the recommendations in the Innovation,
Health and Wealth Report to improve outcomes for individuals, carers and families”
NHS Mandate chapter 7 ‘The broader role of the NHS in society’
“NHS England is committed to ongoing implementation of IHW, which seeks to improve NHS use of innovative treatments for the benefit of patients..”
PPRS chapter 4
The overall expectation is that the IHW refresh would continue to build the strategic direction , update progress and set out next steps, supported by a series of actions and timelines for the next 2-3 years as the next stage in the longer term strategy.

20. Innovation Health and Wealth Refresh Industry proposals
1.Reducing variation and strengthening compliance – continued commitment to the NICE compliance regime
•Rapid and consistent implementation of NICE TAs
•NICE TA recommendations are incorporated automatically included into relevant local NHS formularies and formularies are published
•Continued commitment to and resourcing of the NICE Implementation Collaborative to overcome system wide barriers to implementation of NICE TAs
•Development of the Innovation Scorecard into the new combined metrics report
2.AHSNs – continued commitment to fund AHSNs and greater clarity in their role in improving the adoption of innovative medicines is needed
3.Aligning financial , operational and performance incentives – financial incentives should work to encourage early adoption of NICE TAs.
•Introduction of an integrated national incentive for improved access and uptake of NICE TAs with sanctions/penalties for organisations found to be blocking or restricting patient access to those medicines.
•Align existing incentive schemes
•Regular audit of NICE TA implementation and publication of annual Innovation Returns at organisational level
•Include IHW as a national priority for inclusion in Quality accounts

21. Innovation Health and Wealth Refresh Industry proposals
4.Increasing responsibility and accountability for IHW from national to local level within the NHS
•NHS clinical, operational and financial accountability for IHW delivery needs to be considerably strengthened, from the NHSE Board , through the operational directorate to local levels
•Innovation plans and objectives should be set at every level and audited
•The IHW Implementation Board should be reconstituted and reinstated including senior level representation of NHSE clinical , operations and finance