NHS cost control mechanisms Flashcards
What is the NHS drugs bill?
Handles all of the digital data and expenses of the NHS
Why has the drugs bill increased in recent years?
- People live longer
- More treatments available
- New and expensive treatments
- More preventative medicine
- Publication of treatment guidelines
- Larger and more ageing population
- Rise in obesity and alcohol consumption
- Rise in lifestyle related disease e.g. diabetes, CHD
- Improvements in diagnosis – patients get treatments earlier
Who are the suppliers of primary care?
o Manufacturers
o Importers
o Wholesalers
o Retailers
Who’s in demand of primary care?
o Consumers (patients) o Prescribers
What are the cost control mechanisms for manufacturers?
- The National Health Service (NHS) spends approx £10 billion a year on branded prescription medicines in the UK
- Countries without indigenous pharmaceutical industries main goal to minimise costs to level compatible with efficient supply system
- UK need to ensure balance between viability of pharmaceutical industry and NHS expenditure
What is the 2019 Voluntary Scheme for Branded Medicines Pricing and Access (VPAS)?
- Agreement between DHSC (department of health and social care) and the association of the British pharmaceutical industry (ABPI) on getting the best value and most effective medicines into use more quickly.
- Replaces the pharmaceutical price regulation scheme (PPRS)
What are the voluntary scheme terms?
- Agreement that branded medicines bill will not grow by more than 2% in next 5 years
- Commitment from NHS England to increase uptake of new medicines for the five highest health gain categories to benefit patients
- All new medicines and significant indications routinely appraised by NICE
- Scheme supports small and medium sized companies through exemptions and payment relief to encourage innovation and growth
- Freedom to set list prices is maintain for new active substances (NAS)
How do you control costs through retailers?
- Generic medicines make up 2/3 of prescriptions but are responsible for about 1/5 of drug costs
- NHS controls costs of generic medicines through the drug tariff
What are the three types of cost control on supply side of NHS medicines?
- Profit control on manufacturers (branded products)
- Price fixing of retailers’ reimbursement (generic products)
- Discount adjustment scale (“clawback”) (all dispensed medicines)
What are the controls on prescribers?
• Blacklisted drugs
• SLS
• ACBS
• Appliances
• Reagents
• DPF – formularies (dentists)
• NICE
• National Service Frameworks
• Formularies
o Joint secondary care/ primary care – being Rxed something in hospital and then in community when discharged
• Generic prescribingWhat is the low priority prescribing project?
• NHS England guidance to GPs and CCGs to remove 18 ineffective, unsafe and low clinical value treatments:
o dietary supplements
o herbal treatments and homeopathy,
• Saving up to £141 million a year.
• These savings form part of the NHS efficiency plan contained in the Next Steps on the NHS Five Year Forward View
What are the current prescription charge arrangements in the UK?
Fixed NHS charge per item dispensed (regardless of cost, number or volume of medicine)
What countries pay for prescriptions?
ONLY England (not Wales, Scotland or Northern Ireland)
What are prepayment certificates?
a. Provide ceiling on NHS Rx cost
b. A 12-month certificate is £104.00 and saves money if need 11 items or more per year
What are the exemption groups in the UK?
o Age: < 16 or >60
o 16-18 and in full-time education
o Condition: pregnant or up 12 months post-natal
o Clinical condition and have a valid medical exemption certificate (MedEx) : permanent fistula, endocrine insufficiency, epilepsy, housebound, cancer
o Low Income: recipient of income support, family credit etc
• Free provision of oral contraceptives
