BNF section with leading net ingredient cost?
Diabetes drugs
- 44.6 million diabetes prescription items were dispensed in the community; a 50% rise over 6 years
Which drugs have the greatest increase in volume of prescribing?
Antidepressants
What was the change in dispensing of generics since 2001?
increase from 52% to 72%
Reasons for the increase in drugs bill?
- more treatments available
- new and expensive treatments
- increased preventative medicine
- publication of treatment guidelines
- larger and ageing publication
- rise in obesity and alcohol consumption
- rise in lifestyle related disease
- improvements in diagnosis, patients get treated earlier
Who controls the supply of medicines to the NHS?
manufacturers, importers, wholesalers, retailers
Who controls the demand of medicines in the NHS?
patients and prescribers
Cost control mechanisms: manufacturers
- 10b spend on branded medicines
- Countries without indigenous pharmaceutical industries main goal to minimise costs to level compatible with efficient supply system
What is the PPRS?
Pharmaceutical price regulation scheme
Indirectly controls prices of branded products
dispensed under NHS
by limiting the % of income allowed as profit from total UK sales of medicines to NHS (currently 21%) - also limits R&D and promotion
Principles of the PPRS?
- First established on voluntary basis in 1957 and is renewed every 5 years (most recent 2014)
- Agreement between DH and the Association of the British Pharmaceutical Industry (ABPI)
Objectives of the PPRS?
- Secure provision of safe and effective medicines for the NHS within affordable limits
- Promote a strong and profitable pharmaceutical industry (capable of R&D)
- Encourage efficient and competitive development and supply of medicines to pharmaceutical markets in UK and other countries
Effect of the PPRS on the pharmaceutical industry?
- does not reduce the size of the market, just controls profits made from the NHS
- Allows companies to compete freely with other manufacturers and agree NHS list prices
- Can negotiate individual prices with bulk purchasers, e.g.
hospital or
pharmacy chains
What medications does PPRS cover?
The PPRS covers all licensed, branded, health service medicines supplied by members of the scheme
What medications does PPRS not cover?
- sales of products on private prescription or other use outside the health service in the UK;
- products without a brand name (generics);
- branded products available without prescription (over the counter (OTC) medicines), except when these are prescribed
What are the types of cost control on supply of NHS medicines?
- profit control on manufacturers
- price fixing on retailers
- discount adjustment scale (clawback)
How are prescribing budgets arranged?
- hospital and primary care used to have separate budgets
- now one pot in CCGs to cover all prescribing costs
How can costs of medicines be controlled by consumers?
- deregulation of medicines
- prescription charges
How does deregulation of medicines help with cost control?
- patients have access to a wider range of medicines
- Allows pharmacists to recommend greater range of therapeutic options
- no cost to the NHS
Which factors influence the impact of deregulation?
- Licensing of product
- Consumer awareness of product
- Patient exemption
- Whether patient takes routine medication
What is the NHS prescription charge?
- fixed charge per item regardless of cost, number or volume of medicine
- £8.80 as of april 18 - england only
What is a prepayment certificate?
Provide ceiling on NHS Rx cost
A 12 month certificate is £104.00 and saves over £105 if need 2 items per month.
What are the grounds for prescription charge exemption?
- below 16
- over 60
- 16-18 and in education
- pregnant and 12 months post natal
- clinical condition and have a valid medical exemption certificate (MedEx) : permanent fistula, endocrine insufficiency, epilepsy, housebound, cancer
- Low Income: recipient of income support, family credit etc
- free provision of oral contraceptives
What behaviours do patients exhibit as a result of the prescription charge?
- delay getting medicines until paid
- prioritise items - part Rx dispensed
- borrow money to pay for Rx
- dont get Rx dispensed at all
- dont consult GP
- reduce dose or frequency of medicines
Kings fund recommendation for prescription charge?
reduce fee to £2.50 per item
- abolish exemptions and low income scheme
- retain limit to individual bill (prepayment certificate)
would raise an additional 1bn per year
Other ways to reduce the drugs bill?
- reduce waste on unused medication (through MURs, NMS, patient education)
- further POM to P switches
- improve public health
