ABPI Scotland: Medicines in Scotland

Membership body of the Pharmaceutical Industry – statutory negotiating body Represents majority of research based companies Members supply over 90% of medicines to the NHS 2/3 rd of all research and development of new medicines is undertaken by member companies ABPI Code of Practice - administered by PMCPA What is ABPI? 2

The pharmaceutical industry globally invests more in research and development than any other industry – £12.1 million every day. The pharmaceutical industry employs around 25,000 people in R&D in the UK (Business Enterprise Research and Development (2008, 2009, 2010) 2010 released Nov 2011 – Office for National Statistics (ONS). Investment 3

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Uptake and innovation Pricing: is it a barrier to uptake? Clinical research: are we under threat? Who we are and how we operate 5 ABPI: Key issues...

Uptake and innovation – Low and slow 6 ABPI: Key issues...

Market share of innovative products in the UK is behind European peers and deteriorating (1)IMS Health World Review Analyst, 2010 (2)OHE analysis 2012 Market share for products -brands and generics- launched in the past 5 years by value (%) (1) NICE’s ~40% rejection rate and NICE ‘blight’ lead to delays and limited access as well as poor performance in innovation uptake (2) 7 Branded medicines launched in the past 5 years are expected to account for 5% of spend only by 2015, similar to previous years’ levels

Uptake of new medicines in Scotland (OHE stats) 8

Scottish Government recognised there is a problem: o CEL 17 (and follow-up CMO) o Statement of Intent o New medicines review (recently announced) Scottish Parliament has recognised there is a problem: o Public Petitions Committee inquiry o Health & Sport Committee Inquiry (ongoing) 9 Uptake of new medicines in Scotland...

Pricing: is it a barrier to uptake? 10 ABPI: Key issues...

Overall, UK spending on medicines as a percentage of GDP (developed countries)… (1) IMS Health World Review Analyst OECD Health Database. All data accessed March 2012 Spending on medicines as a percentage of GDP in various countries in 2011 (1) 11 If Spain cut down pharmaceutical spend by 20%, the proportion of GDP would be 1.2%, i.e. still higher than in the UK’s

The UK has severe uptake issues in critical therapy areas 12 The UK has the lowest per capita spend in cancer medicines launched in the past 5 years (1)IMS Midas 2006 £ Spend per capita on cancer medicines launched in the previous 5 years in Europe (£) (1)

Branded pharmaceutical prices are amongst the lowest in developed countries USA190USA176USA183USA252USA281USA331 Germany102Germany106Germany113Germany142Germany155Germany153 UK100UK100Ireland112Ireland134Australia139Australia143 Finland98Ireland99Sweden105Belgium122Ireland133Sweden134 Austria94Finland96Belgium101Finland119Sweden130Belgium123 Netherlands93Austria94UK100Sweden116Belgium122Ireland123 Belgium91Netherlands92Finland99Netherlands115Austria117Netherlands117 France91Belgium90Netherlands99Austria111Italy113Austria115 Italy90Italy90Austria96Spain109Spain106France104 Spain81France84Australia94France108Finland105Finland103 Australia -Spain80France92Italy101France104Italy101 Ireland -Australia -Spain88UK100UK100Spain101 Sweden - -Italy83Australia94Netherlands-UK100 (1) OHE, 11th Report ( ); 5th Report ( ); 2011: OHE calculations based on IMS and PCA data. Note: blank cell = Not available Notes: Table includes the years prior to PPRS negotiations (2003/2004; 2007/2008) as well as for 2010 and 2011 Exchange rate used: Average of Q4 of every year. Position of the UK in the ranking of branded pharmaceutical prices by year (1) 13 In a recent report (September 2012) The European Commission has indicated that the UK is a highly efficient medicines market

Total medicines bill for NHSScotland is projected to increase by 2.9% - 3.9% (£1.37bn - £1.43bn) Branded medicines bill for NHSScotland is projected to increase by 0.5% - 1.5% (£0.99bn – £1.03bn) 14 Betweeen 2011 and 2015 ( at list prices - OHE )...

Clinical research: are we under threat? 15 ABPI: Key issues...

While the pharma sector contributes 1 in 2 R&D pounds in the UK (1), it is in decline % of global sales of leading 100 medicines by country of origin National origin of leading 100 global medicines by sales 2004–2011 (2) 16 Twelve major pharmaceutical site closures between 1996 and 2012 (4) (1)ONS UK Business Enterprise Research and Development, 2009 (2)Department of Health, MISG, Pharmaceutical Industry: Competitiveness and Performance Indicators 2009 (3)Centre for Medicines Research ( Global Clinical Performance Metrics Database; Kinapse report (4)ABPI analysis UK Global Share of patients in clinical trials 2000 – 2010 (3) % % 2% -77%

Evidence given to the Health & Sport Committee inquiry into new medicines from: –a group of 17 oncologists –Oral evidence of a further oncologist –Cancer Research UK: “The UK’s lower rate of uptake for new cancer drugs may be damaging to our ability to design and run internationally competitive studies. If very few patients can get licensed drugs that are the standard of care outside the UK, this could lead to fewer industry-supported trials being conducted in the UK” 17 Don’t just take our word for it...

A changing relationship

The industry position on trial registry and the publication of results ABPI Code of Practice 2012 all trials must be registered within 21 days of the initiation of patient enrolment results positive or negative, must be published within one year of marketing authorisation

Where will we be in 2016? On transparency of financial relationships Payments to health professionals across Europe will be publicly declared Medical Education Grants to Healthcare Organisations will be publicly disclosed All payments to patient organisations will be publically disclosed On access to clinical trial and safety information All trials are registered All results published within one year of marketing authorisation Results from past trials accessible via the EMA criteria Proactive publication of unprecedented levels of safety data for all marketed medicines in the EU

The future… 21

Harder and more expensive to develop medicines – no more blockbusters… Personalised medicines… Less money, more patients… –Health & social care integration –Long term conditions –Move away from acute care The future… 23

Thank you… Andrew Powrie-Smith – 24