NHS costs

Question 1

the cost of the NHS is ______. value?

Answer 1

increasing

currently around £13 billion

Question 2

hospital use accounts for around ____ of the total cost at list price. this is also _____

Answer 2

50%

increasing

Question 3

why are costs in hospital increasing?

Answer 3

more complex conditions
more complex formulations and drugs
consultants will Rx more complex drugs than GP

Question 4

what type of drugs have the greatest increase in volume of prescribing?

Answer 4

antidepressants

Question 5

generic drugs are dispensed _______ than branded

Answer 5

more, about 72%

Question 6

what types of drugs have the net ingredient cost?

Answer 6

diabetes

Question 7

why are drugs increasing?

Answer 7

higher life expectancies 
chronic conditions 
more diagnosis's 
increasing knowledge 
new drug development 
diagnosis is improving 
lifestyle
preventative medicines 
treatment guidelines

Question 8

NHS spends ______ on branded medicines in the UK compared to generic

Answer 8

MORE

Question 9

What is a way to control the costs of medicines?

Answer 9

reduce/ control the cost of supply

Question 10

why can reducing the cost of supply not be straightforward/ easy?

Answer 10

industries do contribute to the economy- we want them to succeed
therefore need a balance between industry viability and NHS expenditure

Question 11

what is the Voluntary scheme for branded medicines ricing and access? (VPAS)

Answer 11

agreement between DHSC and association of the British pharmaceutical industry

Question 12

what does VPAS replace?

Answer 12

the pharmaceutical price regulation scheme- there was issues with this

Question 13

when is the VPAS starting?

Answer 13

January 2019

Question 14

what does the VPAS entail?

Answer 14

agreement that branded medicines bill will not grow by more than 2% in the next 5 years

Question 15

why does this 2% cap help

Answer 15

so the NHS knows they won’t spend loads of money?

Question 16

what do the industries get in return?

Answer 16

a commitment from NHS England to increase uptake of NEW medicines for the five highest health gain categories

Question 17

what are these five highest health gain categories?

Answer 17

we dont know them yet

Question 18

what else do these branded medicines get with the VPAS?

Answer 18

all new medicines will be routinely appraised by NICE- didn’t happen before so GPs wouldn’t use them

Question 19

who does the VPAS scheme support?

Answer 19

small and medium sized companies through exemption and payment relief to encourage innovation and growth

Question 20

does the VPAS put any cap on the price of new active substances

Answer 20

NO, the industry can se the price as long as they stay under the 2% cap for the following 5 years

Question 21

consequences of the voluntary scheme?

Answer 21

get best medications to patients quickly
faster adoption of the most clinically and cost effective medicines
maintain affordability of branded medicines
delivering safe and effective medicines at reasonable prices
support industry

Question 22

how does the NHS control costs of generic medicines?

Answer 22

through the drug tariff as there’s so many of them

Question 23

3 Types of cost control on supply side of NHS medicines?

Answer 23

• profit control on manufacturers for BRANDED
• price fixing of retailers’ reimbursement- GENERIC
• discount adjustment scale- clawback

Question 24

what is clawback?

Answer 24

pharmacies get wholesalers discount, so the NHS clawback for of the discount they expect you to get

Question 25

another way of controlling the cost of NHS medicines bill in primary care- instead of supply?

Answer 25

control demand- repress demand

Question 26

how does the NHS control prescribers?

Answer 26

black list
selected list schemes- Rx things only for certain people
advisory committee on borderline substances- only for certain conditions
formularies- DPF, NPF
NICE guidelines
generic Rxing instead of brands

Question 27

what’s the low priority prescribing project?

Answer 27

NHS England guidance to GPs and CCGs to remove 18 ineffective, unsafe and low clinical value treatments

Question 28

examples of these treatments

Answer 28

dietary supplements
herbal treatments
homeopathy

Question 29

how much does the LPPP save the NHS?

Answer 29

£141 Million a year

Question 30

what is the impact of deregulation of prescription medicines? aka making them OTC

Answer 30

patients have a greater access
allows pharmacists to recommend a greater range
no cost to NHS

Question 31

Factors affecting the impact of deregulation?

Answer 31

• licensing of products- some are only licensed OTC for certain conditions
• consumer awareness of product
• patient exemption- so why would they go pay for it

Question 32

fixed charge for England, Scotland NI and Wales for NHS Rx charge PER ITEM

Answer 32

E- £9.00
S- na
NI- na
W- na

Question 33

how can non exempt people reduce their costs?

Answer 33

Prepayment certificate- 12 month certificate is £104.00

Question 34

__/10 Rx’s are free

Answer 34

9

Question 35

how can costs reduce patient adherance?

Answer 35

delaying getting Rx till paid
prioritise items 
borrowing money 
dont get Rx at all 
dont consult GP 
reduce dose frequency

Question 36

what does the Kings fund propose?

Answer 36

reducing Rx charges to £2.50 per item, but abolishing medical exemptions and the low income scheme so everyone pays

Question 37

does the king fund change the prepayment certificate

Answer 37

no, retained £104

Question 38

how much money would the kings fund raise?

Answer 38

£1 billion

Question 39

other ways to further reduce the drugs bill?

Answer 39

WASTE
Further POM to P switches
improving public health