Summary: NHSI data suggests that in the region of £200m of savings were being achieved from switching to just three “biosimilars” instead of the original “biologic” medicine. What does this mean for the future of medical provision in the NHS?
What are biosimilars and biologic medicines?
Biologics are complex medicines which are expensive to manufacture and are correspondingly costly for the NHS. A number have recently come off patent, resulting in cheaper biosimilars becoming available. A commissioning framework was produced last Autumn to help CCGs work with providers to achieve these savings.
Which drugs have made the savings?
Savings from using biosimilar infliximab, which is used to treat rheumatoid arthritis and inflammatory bowel disease, were nearly £77m in the 90 per cent of trusts tracked in the first 10 months of the year, with uptake of 92.9 per cent. Etanercept (also used for rheumatology conditions) was used in 87.7 per cent of cases with a saving of nearly £42m. Although takeup of the more recently launched biosimilar ritiximab (used for some cancers as well as rheumatoid arthritis) was lower at 63 per cent, it still saved £33m.
Who gets the savings?
All of these drugs are normally prescribed in hospitals, rather than by GPs. However, clinical commissioning groups and specialised commissioners can benefit from savings where they pay for those medicines via “pass through funding”. There may be some cases where trusts and CCGs may have worked together on gainshare arrangements too incentivise trusts to use biosimilars.
Is there potential to go further?
There are still significant variations in uptake between different hospitals of the available biosimilars but there were potential savings of up to £300m a year. Later this year, the main UK patent on anti-inflammatory drug Humira (adalimumab) is expected to expire: this is the highest spend drug in NHS hospitals at more than £250m a year, which could be significantly reduced if biosimilars are prescribed instead.
What does the industry say?
Michelle Hoffman in StatNews set out some issues stateside causing slow uptake of biosimilars: “…could be due to the current lack of “interchangeability,” meaning that the pharmacy cannot automatically switch prescriptions from an innovator drug to a biosimilar without physician approval the way they do for small-molecule generics. It could also be that despite the label, biosimilars do not have the real-world evidence across indications that innovator drugs may have. Lack of physician and patient awareness of biosimilars may also be to blame.”
Kavya Gopal, chair of the British Biosimilars Association and head of specialty at Sandoz UK, said: “The NHS has moved quickly to achieve the savings from biosimilar medicines and has become an example for healthcare systems across the world in the adoption of these medicines. What is crucial now is that the NHS continues to treat these medicines as a long-term opportunity for patients and ensure that competition is maintained in the market, and pricing is not pushed to unsustainable levels.”
Andrew Davies, professional lead for hospital pharmacy at NHS Improvement, said: “NHS trusts have worked incredibly hard to realise the potential savings of switching to high quality, good value biosimilar medicines rather than prescribing the originator biological medicine. From these three regularly prescribed medicines alone, patients have continued to receive high quality treatments, while trusts have saved the NHS over £170m in the last year which can be reinvested into treating more patients.”