Transcript Pharmacy Procurement: A Customer View (Christine Gilmour)

Pharmacy & National
Procurement
Christine Gilmour
Chief Pharmacist NHS Lanarkshire
Overview
1
Background
2
Life before National Procurement
3
Current Situation
4
What’s Next?
Overview
1
Background
2
Life before National Procurement
3
Current Situation
4
What’s Next?
Principles of Medicine Purchasing
(in the managed service)
 Pharmacy
= single purchase point
 Pharmacy decides what to buy
 No non-stock
 Purchase order every time
Medicines
Generic
Branded

<20%
of spend

>80% of spend

Patent Expired

Patent protected

Multiple suppliers

Single supplier

Ability to tender

No deal
Primary Care

Bulk of NHS medicine spend is in primary care

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.
Branded Medicines

Branded medicines = ~80% of the NHS drug
spend

Prices of branded medicines are controlled by
the Pharmaceutical Price Regulation Scheme
(PPRS).

Therapeutic tendering has been challenged
Pharmaceutical Price Regulation Scheme
(PPRS)

Is a reserved matter negotiated by DoH

Is a voluntary agreement

Regulates UK market for branded medicines.

Allows manufacturers to make a capped level of profit
in relation to their investment.

Manufacturers are able to modulate prices across a
product range
Overview
1
Background
2
Life before National Procurement
3
Current Situation
4
What’s Next?
Pre-National Procurement
 National
Contracts facilitated via CSA.
 Contracts award = 1 meeting of a pharmacy
panel
 Good compliance with contracts
 Hospital loss leaders
 White Pages and Blue Pages
 Local deals and bulk contracts
Overview
1
Background
2
Life before National Procurement
3
Current Situation
4
What’s Next
Current Situation

Procurement

Shortages

Patient Access Schemes

Medicine Homecare Services

Access to Medicines in Primary Care

Few, if any, local deals – no bulk purchases
* Governance
Framework *
Pharmacy Team within NP
Pharmacy Procurement Governace Framework
DoPs Group
National
Procurement
NAPS
SPAA
Emergency
Planning Leads
Network
Other Networks &
Special Interest
Groups
Pharmacologistics
Operational
Group
Pharmacy zones
Pharmacologistics Steering
Group
Pharmacy
Business
Technology Group
Homecare Short
Life Working
Group
Unlicensed
Medicines
Advisory Board
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.
Definitions:
Medicine Homecare Services
Low tech




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
Patient self-administration
Oral medicines (excluding oral oncology) or external use
Licensed medicines, uncomplicated devices.
No complex storage requirements
Overview
1
Background
2
Life before National Procurement
3
Current Situation
4
What’s Next?
Whole New Agenda!

Shortages

Patient Access Schemes

Access to Medicines in Primary Care

Medicine Homecare Services

Complex discount schemes

Biosimilar medicines

European Medicines Verification System

Managing Suppliers

Optimising efficiency of procurement & supply
chain

Shortages

Patient Access Schemes

Access to Medicines in Primary Care

Medicine Homecare Services

Complex discount schemes

Biosimilar medicines

European Medicines Verification System

Managing Suppliers

Optimising efficiency of procurement & supply
chain
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

Shortages

Patient Access Schemes

Access to Medicines in Primary Care

Medicine Homecare Services

Complex discount schemes

Biosimilar medicines

European Medicines Verification System

Managing Suppliers

Optimising efficiency of procurement & supply
chain
Complex Discounts




Not business as usual
Each is unique
Usually involve individual patient tracking
Need to ensure they do not dictate patient
pathways of care.

Shortages

Patient Access Schemes

Access to Medicines in Primary Care

Medicine Homecare Services

Complex discount schemes

Biosimilar medicines

European Medicines Verification System

Managing Suppliers

Optimising efficiency of procurement & supply
chain
Biologics & Biosimilars

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

Much debate as to whether patients can or should be switched
from one biosimilar to another.

Biosimilars are just emerging on to the market

Shortages

Patient Access Schemes

Access to Medicines in Primary Care

Medicine Homecare Services

Complex discount schemes

Biosimilar medicines

European Medicines Verification System

Managing Suppliers

Optimising efficiency of procurement & supply
chain
European Medicines Verification System