1. Contracting of Branded Medicines Philip Aubrey Chair – Branded Medicines Sub Group of PMSG PDIG Symposium 10 th Nov 2011

2. Introduction How are branded medicines currently tendered and recent changes? What is therapeutic tendering? Branded medicines on therapeutic tenders? How can we successfully implement therapeutic rationalisation? Therapeutic tendering – case studies? What does the future look like?

3. Tendering of Branded Medicines Historically conducted at SHA level NHS CMU conducts all tenders – excluding Y&H therapeutic tender 2011 – now national contract for agreed list of branded medicines - covers all England including Y&H Contract commences 1 st Dec 2011 for 2 years with an option to extend for a further 2 years Therapeutic tenders at SHA level – usually 1 year with option to extend for a further 1 year

4. What is Therapeutic tendering The tendering of medicines within specific therapeutic classes Although not all medicines are the same they can have similar efficacy, safety profiles and clinical evidence Stakeholder engagement and robust clinical evaluations are key to therapeutic tendering Suppliers have the opportunity to tender differential pricing on volumes within a therapeutic market Suppliers – risks and opportunities

5. Therapeutic Tendering Matrix

6. Stakeholder Engagement LPP MUPP Steering Group PCT Pharmaceutical Advisors Hospital Clinicians /GPs NHS CMU Clinical Pharmacists Procurement Pharmacists Formulary Pharmacists Commissioners Trust LPP Pharmacy Leads

7. Branded Medicines on Therapeutic Tenders Anti TNFs Antiretrovirals Antifungals Botulinum toxin Erythropoesis stimulating agents Fibrinolytics GCSF Gonadorelin analogues Growth Hormone Hepatitis C Oral anticoagulants

8. How can we successfully implement therapeutic rationalisation Comprehensive stakeholder engagement Supplier conditioning to explain our objectives and therapeutic tendering models Clinical input into decision making Formation of agreed clinical guidelines Provide NHS trusts with projected cost efficiency savings Recommendations to NHS trusts on how to implement locally Regular monthly tracking of volumes, savings and lost opportunity data

9. Case Studies

10. Pan London Antiretroviral Therapeutic Tender 2011 - a clinical exercise Traditional tender and therapeutic tender Suppliers asked to submit prices related to various volume thresholds Adjudication panel includes: – Medicine Procurement Specialists – Pharmaceutical Advisor to LSCG – Lead HIV Clinicians – Lead HIV Pharmacists – Commissioners – Patient Group Representatives – Facilitated by NHS CMU

11. Pan London Antiretroviral Therapeutic Tender 2011 – a clinical exercise Following adjudication a clinical guideline was drafted by key HIV Lead clinicians Clinical guideline presented to and agreed by all London HIV Lead Clinicians Contract commenced 1 st April 2011 Currently monitoring implementation of clinical guideline

12. Pan London Antiretroviral Therapeutic Tender 2011 – a clinical exercise Projected savings: “Traditional” tender – potentially upto £1m over two years Therapeutic tender - £8m over two years

13. Erythropoesis Stimulating Agents ESAs are tendered on patient number bandings Tenders are for product and homecare services Currently 3 contracts in London Pan London contract from 1 st Jan 2013

14. Erythropoesis Stimulating Agents - short acting tender matrix

15. London ESA Market Share

17. What does the future look like? Budget constraints - £20 billion savings across the NHS over 3 years How do we fund patient number growth? How do we fund high cost drugs? Therapeutic tendering is a proven model to increase leverage on prices in a branded market Switching patients will happen where clinically appropriate True win-wins between NHS and Pharma Branded Medicines Sub Group of PMSG to manage branded markets nationally

18. Any questions?