NHS could be offered incentives to switch to biosimilars


A wave of new biosimilar drugs is being launched across Europe, with many more to come in the next few years, offering healthcare systems the chance to save billions on expensive biological drugs.

Healthcare systems in Europe are keen to maximise savings from biosimilars, but lingering doubts about whether they can match the clinical benefits of originator drugs, and complexities in switching new and existing patients are proving to be a barrier.

NHS England is trying to keep the lid on a specialist care budget which is skyrocketing, mainly thanks to a surge of new, high-cost specialist drugs hitting the market.

The organisation is looking at various ways to increase efficiencies and improve patient services at the same time, a tall order as health service finances are at breaking point.

One new idea is to provide financial incentives for frontline budget holders to move over to biosimilars more quickly.

Malcolm Qualie, pharmacy lead, specialised services at NHS England, says incentives to switch to biosimilars could help reduce the pressure on NHS budgets.

Speaking in London at the Ethical Medicines Industry Group (EMIG) conference on specialised commissioning, he joined other NHS leaders in looking at how the NHS could manage the growth of specialised medicines over the next few years.

Qualie is one of NHS England's key decision makers in specialised care drugs. Happy to engage with industry, he is nevertheless focused on driving a hard bargain with pharma to get the best value for money, and incentives for biosimilars use could be introduced in the near future.

One of the first drug classes to face biosimilar competition are the anti-TNF drugs, and Hospira and Celltrion were among the firms to launch biosimilar versions of Remicade (infliximab) across Europe in February this year.

Both drugs are around 50 per cent cheaper than Janssen/MSD's Remicade.

Qualie says commissioners could agree a 'year of care' tariff at a price which provides savings against the originator product but would also allow Trusts 'a gain share opportunity' – a chance to hold on to any savings made from the switch to a biosimilar.

The level of annual payment would be reviewed as more biosimilar is used, but this could translate into savings of thousands of pounds for each patient treated.

This would give the Trusts a major incentive to switch and translate into system-wide savings of millions. Estimates vary as to how much the NHS and other European healthcare systems can save from biosimilars, though many are only 15-35 per cent cheaper than the originator, a far smaller discount compared to generic small-molecule drugs.

Hospira, which markets its infliximab biosimilar Inflectra, says Europe as a whole could save €20 billion by 2020.

Another top-selling drug now facing biosimilar competition in the UK is Sanofi's insulin product Lantus (insulin glargine) – Lilly and Boehringer Ingelheim's biosimilar Abasaglar was launched in August.

Healthcare payers are eager for biosimilar versions of top-selling biotech cancer drugs as well. One of the first expected is a copy of Roche's breast cancer drug Herceptin (trastuzumab), which could be available in 2016.

NHS England recently published 'What is a Biosimilar Medicine?' – a guide aimed at clearing up confusion about the drugs for clinicians and patients.

Malcolm Qualie stressed that spending in secondary care had risen by 15 per cent over each of the last two financial years, and showed no sign of slowing down. NHS England oversees an annual budget of 26 billion, of which around 14 billion goes towards specialised commissioning. The budget's rapid growth, far greater than the increase in the overall NHS budget, is putting enormous pressure on the health service.

The industry points to the PPRS pricing agreement, which guarantees rebates to the NHS after spending exceeds a certain level, but Qualie indicated that payments from the industry are "always on catch up" so are unlikely to keep budgets from overspending. Other initiatives unpopular with pharma, such as introducing a tendering system for hepatitis C treatments and other drugs, are also being rolled out.

The industry, as represented by EMIG and the Associaton of the British Pharmacetical, has grown increasingly frustrated by the PPRS deal not helping to increase uptake of new medicines. UK pharma is pinning its hope on the Accelerated Access Review (AAR) coming up with new ways to make market access easier -but the cost-saving measures being enforced in England are likely to prevail above any other initiative.

'Frontloaded' £3.8 billion

The conference coincided with news that the NHS in England would receive an extra £3.8 billion in funding in its 2016/17 financial year to fund all services, beginning in April. This sum is, however, merely a 'frontloading' of an extra £8.4 billion promised over the period up to 2021.

The funds have been confirmed a day ahead of Chancellor George Osborne's autumn spending review, which is being announced today.

Despite releasing these extra funds earlier, many NHS managers and health think tanks are warning that the health service is under unprecedented pressure. Two thirds of trusts are in deficit, and the NHS in England is expected to record an overall overspend of £2.4 billion at the end of this financial year.

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Andrew McConaghie