1. Pharmacy & National Procurement Christine Gilmour Chief Pharmacist NHS Lanarkshire

2. Overview Background Life before National Procurement Current Situation What’s Next? 1 2 3 4

3. Overview Background Life before National Procurement Current Situation What’s Next? 1 2 3 4

4. Principles of Medicine Purchasing ( in the managed service) Pharmacy = single purchase point Pharmacy = single purchase point Pharmacy decides what to buy Pharmacy decides what to buy No non-stock No non-stock Purchase order every time Purchase order every time

5. Medicines Generic < 20% of spend Patent Expired Multiple suppliers Ability to tender Branded >80% of spend Patent protected Single supplier No deal

6. Primary Care Primary Care Bulk of NHS medicine spend is in primary care Bulk of NHS medicine spend is in primary care Generic drug prices controlled via Drug Tariff Generic drug prices controlled via Drug Tariff Medicines are sourced and purchased by the community pharmacy contractor who is then reimbursed at tariff or list price. NHS does not buy the medicines. Medicines are sourced and purchased by the community pharmacy contractor who is then reimbursed at tariff or list price. NHS does not buy the medicines.

7. Branded 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 Pharmaceutical Price Regulation Scheme (PPRS). Prices of branded medicines are controlled by the Pharmaceutical Price Regulation Scheme (PPRS). Therapeutic tendering has been challenged Therapeutic tendering has been challenged

8. Pharmaceutical Price Regulation Scheme (PPRS) Is a reserved matter negotiated by DoH Is a reserved matter negotiated by DoH Is a voluntary agreement Is a voluntary agreement Regulates UK market for branded medicines. Regulates UK market for branded medicines. Allows manufacturers to make a capped level of profit in relation to their investment. Allows manufacturers to make a capped level of profit in relation to their investment. Manufacturers are able to modulate prices across a product range Manufacturers are able to modulate prices across a product range

9. Overview Background Life before National Procurement Current Situation What’s Next? 1 2 3 4

10. Pre-National Procurement National Contracts facilitated via CSA. National Contracts facilitated via CSA. Contracts award = 1 meeting of a pharmacy panel Contracts award = 1 meeting of a pharmacy panel Good compliance with contracts Good compliance with contracts Hospital loss leaders Hospital loss leaders White Pages and Blue Pages White Pages and Blue Pages Local deals and bulk contracts Local deals and bulk contracts

11. Overview Background Life before National Procurement Current Situation What’s Next 1 2 3 4

12. Current Situation Procurement Procurement Shortages Shortages Patient Access Schemes Patient Access Schemes Medicine Homecare Services Medicine Homecare Services Access to Medicines in Primary Care Access to Medicines in Primary Care Few, if any, local deals – no bulk purchases Few, if any, local deals – no bulk purchases * Governance Framework *

13. Pharmacy Team within NP

14. Pharmacy Procurement Governace Framework Pharmacologistics Operational Group Pharmacy zones Pharmacy Business Technology Group Homecare Short Life Working Group Unlicensed Medicines Advisory Board Pharmacologistics Steering Group National Procurement DoPs Group NAPS SPAA Emergency Planning Leads Network Other Networks & Special Interest Groups

15. Clinical Advisory Panels Actions 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.

16. Medicine 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:

17. Overview Background Life before National Procurement Current Situation What’s Next? 1 2 3 4

18. Whole New Agenda!

19. Shortages Shortages Patient Access Schemes Patient Access Schemes Access to Medicines in Primary Care Access to Medicines in Primary Care Medicine Homecare Services Medicine Homecare Services Complex discount schemes Complex discount schemes Biosimilar medicines Biosimilar medicines European Medicines Verification System European Medicines Verification System Managing Suppliers Managing Suppliers Optimising efficiency of procurement & supply chain Optimising efficiency of procurement & supply chain

20. Shortages Shortages Patient Access Schemes Patient Access Schemes Access to Medicines in Primary Care Access to Medicines in Primary Care Medicine Homecare Services Medicine Homecare Services Complex discount schemes Complex discount schemes Biosimilar medicines Biosimilar medicines European Medicines Verification System European Medicines Verification System Managing Suppliers Managing Suppliers Optimising efficiency of procurement & supply chain Optimising efficiency of procurement & supply chain

21. Access 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

22. Shortages Shortages Patient Access Schemes Patient Access Schemes Access to Medicines in Primary Care Access to Medicines in Primary Care Medicine Homecare Services Medicine Homecare Services Complex discount schemes Complex discount schemes Biosimilar medicines Biosimilar medicines European Medicines Verification System European Medicines Verification System Managing Suppliers Managing Suppliers Optimising efficiency of procurement & supply chain Optimising efficiency of procurement & supply chain

23. Complex Discounts Not business as usual Not business as usual Each is unique Each is unique Usually involve individual patient tracking Usually involve individual patient tracking Need to ensure they do not dictate patient pathways of care. Need to ensure they do not dictate patient pathways of care.

24. Shortages Shortages Patient Access Schemes Patient Access Schemes Access to Medicines in Primary Care Access to Medicines in Primary Care Medicine Homecare Services Medicine Homecare Services Complex discount schemes Complex discount schemes Biosimilar medicines Biosimilar medicines European Medicines Verification System European Medicines Verification System Managing Suppliers Managing Suppliers Optimising efficiency of procurement & supply chain Optimising efficiency of procurement & supply chain

25. Biologics & Biosimilars Expensive to research, develop, manufacture and bring to the market – hence the very high prices charged. Expensive to research, develop, manufacture and bring to the market – hence the very high prices charged. The same molecule manufactured by another company is known as a biosimilar The same molecule manufactured by another company is known as a biosimilar Much debate as to whether patients can or should be switched from one biosimilar to another. Much debate as to whether patients can or should be switched from one biosimilar to another. Biosimilars are just emerging on to the market Biosimilars are just emerging on to the market

26. Shortages Shortages Patient Access Schemes Patient Access Schemes Access to Medicines in Primary Care Access to Medicines in Primary Care Medicine Homecare Services Medicine Homecare Services Complex discount schemes Complex discount schemes Biosimilar medicines Biosimilar medicines European Medicines Verification System European Medicines Verification System Managing Suppliers Managing Suppliers Optimising efficiency of procurement & supply chain Optimising efficiency of procurement & supply chain

27. European Medicines Verification System