Pharmacy

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Pharmacy National Procurement

• Christine Gilmour
• Chief Pharmacist NHS Lanarkshire

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Overview
Background
1
Life before National Procurement
2
Current Situation
3
Whats Next?
4
3
Overview
Background
1
Life before National Procurement
2
Current Situation
3
Whats Next?
4
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Principles of Medicine Purchasing(in the managed
service)

• Pharmacy single purchase point
• Pharmacy decides what to buy
• No non-stock
• Purchase order every time

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Medicines

• Generic

• Branded

• lt20 of spend
• Patent Expired
• Multiple suppliers
• Ability to tender

• gt80 of spend
• Patent protected
• Single supplier
• No deal

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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.

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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

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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

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Overview
Background
1
Life before National Procurement
2
Current Situation
3
Whats Next?
4
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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

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Overview
Background
1
Life before National Procurement
2
Current Situation
3
Whats Next
4
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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

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Pharmacy Team within NP
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Pharmacy Procurement Governace Framework
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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.

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Medicine Homecare Services
Definitions
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

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Overview
Background
1
Life before National Procurement
2
Current Situation
3
Whats Next?
4
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Whole New Agenda!
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• 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

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• 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

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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

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• 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

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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.

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• 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

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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

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• 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

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European Medicines Verification System
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