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

Declaration of payments Pads & pens Clinical trial transparency Interaction with patient groups 3 Trust & reputation?

Participation in National groups – SMC, PASAG, PAPIG, LiSAB, Medical Directors group, Strategic Engagement Group, SIGN implementation group, NRS Industry partnership group 2 strategic groups – SAVG, SLSG 9 Therapy specific groups Collaboration - > A Common Understanding 2012 – Working together for Patients 4 ABPI in Scotland

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 5

6

Uptake and innovation Pricing: is it a barrier to uptake? Clinical research: are we under threat? 7 ABPI: Key issues...

Uptake and innovation – Low and slow 8 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) 9 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) 10

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) 11 Uptake of new medicines in Scotland...

Pricing: is it a barrier to uptake? 12 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) 13 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 14 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)

Poor uptake of innovative medicines in the UK leads to poor patient outcomes 15 The UK has the lowest survival rates in cancer in Europe (1)Eurocare year survival rates in cancer in Europe, men and women (%) (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) 16 In a recent report (September 2012) The European Commission has indicated that the UK is a highly efficient medicines market

The UK has among the highest penetration of and use generics across European countries, c. 65% Source: IMS 2012 (2011 data) Generics market share in Europe by volume % 17 GR 34% BE 35% AT 36% CH 39% IT 40% IE 42% NO 43% ES 45% PT 45% FR 47% FI 49% TK 52% SE 53% NE 63% DK 64% CA 65% DE 65% UK 66% MEAN 49% % GENERIC PRODUCTS % NON GENERIC PRODUCTS

In specific cases, medicines prices drop 90% in price and 95% in volume in the first few years after loss of exclusivity... 18

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) 19 Betweeen 2011 and 2015 ( at list prices - OHE )...

£100m front-line cuts for Scotland’s NHSScotland in Sunday (Nov 25 th 2012) “... On drugs and prescribing, NHS boards claimed many of the savings would accrue by switching from costly branded medicines to generic drugs, no longer covered by commercial patents. “However, they also said reviews were being undertaken by GPs and hospitals to review the volume of prescriptions, the biggest cost driver in recent years.” 20 Volume, not cost as the main driver of rise...?

Clinical research: are we under threat? 21 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) 22 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%

The UK currently has a prominent position in global launch sequences The UK is an early launch market in global pharmaceutical launch sequences 68% of pharmaceutical companies launch new medicines in the UK first (first, second or third market worldwide) 66% of companies anticipate that government’s proposals for a new pricing scheme will adversely affect the UK’s global position in the launch sequence Source: Industry market research, Feb-March 2012

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” 24 Don’t just take our word for it...

The future… 25

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… 26

Access to new medicines reviews… –Barriers to access? Closer collaboration and partnership working…? The future… 27

Thank you… Keith Small – 28