NHS England (2022) has reportedly saved £1.2 billion on medicines over the course of just 3 years, while still being able to secure state-of-the-art treatments for patients. This is due to NHS England prioritising their finances to aid better negotiations on prices for hundreds of hospital drugs.
Cost-effective drugs
Over the years, cheaper versions of the same drugs have been acquired by NHS England. An example of this is the drug adalimumab (NHS England, 2022), which is used to treat over 45 000 patients with rheumatoid arthritis, inflammatory bowel disease and psoriasis, and has accounted for approximately one-third of these savings. Monoclonal antibodies such as this come at a great cost, but do improve health for thousands of people and reduce pressures on the NHS.
Yokomizo et al (2016) explored the cost-effectiveness of monoclonal antibodies for ulcerative colitis, focusing on the effects of adalimumab, infliximab and vedolizumab. The authors note there being no head-to-head randomised controlled trials (RCTs) that compared the effectiveness of these medications for ulcerative colitis. The aim of the study was to assess cost-effectiveness of these drugs as first-line agents to induce clinical remission and mucosal healing in the disease. The research team created a decision tree that was based on a payer's perspective in the USA, in order to estimate the first year costs of the drugs in achieving clinical remission and mucosal healing in patients with moderate-to-severe disease. They derived the costs from Medicare reimbursement rates and wholesale drug prices.
While it is important to note that this is an American study and that costs and commissions differ between countries, it nonetheless provides some general insight into the cost-effectiveness of such an expensive drug. Yokomizo et al (2016) found that if costs are not excessive (over $2000), infliximab is the most cost-effective, first-line treatment for moderate-to-severe ulcerative colitis. If the cost thresholds were to be exceeded, adalimumab is the most cost-effective, first-line biologic treatment for the disease (Yokomizo et al, 2016). This indicates that for this type of condition, adalimumab is seen as such an effective medication, that it is worth its high cost. Therefore, for the NHS to have negotiated reduced costs for this drug is a great achievement.
The NHS has also saved on similar deals for other unbranded medication deals. Examples include treatment for severe skin conditions and aggressive blood cancers. NHS England (2022) also report savings with life-saving treatments. For example, the gene therapy medication Libmeldy, which is for the treatment of metachromatic leukodystrophy, and Zolgensma, which is a spinal muscular atrophy infusion.
How was it achieved?
Savings can be implemented much more easily once a drug's patent expires. Adalimumab was known under the brand as Humira, but since the patent expired in 2018, various cheaper versions containing exactly the same drug in the same quantities, can be made and sold legally. Under a patent, drug companies charge high costs to cover producing and trialing the drug, as well as to turn sizeable profits. However, when the patent expires, the market is free for all other companies to reproduce the same drug but under other brand names, without incurring the fees that would exist under the patent. The NHS recognised the effectiveness of Humira and ensured it negotiated an excellent deal on a cheaper version of the drug, soon after the patent expired in 2018, being strategic in its cost-saving actions. According to NHS England (2022), the other versions of Humira all contain the same formulation of adalimumab, with the same quality, safety and efficacy of the original brand.
In fact, four out of five medications prescribed in the NHS are now unbranded. This new way of purchasing will require suppliers to hold extra medications on UK soil, ensuring a cheaper, unbranded backup stock, which can be quickly mobilised to doctors so that the first-choice treatment can be accessed, rather than having to resort to a branded version because it is the only version available in the UK.
How will patients save?
Owing to the current cost-of-living crisis, a freeze on prescription charges has been introduced (Department of Health and Social Care (DHSC), 2022). This will save patients a total of £17 million. This is the first freeze in 12 years on prescription charges, with charges remaining at £9.35 for a single charge or £30.25 for a 3-month prescription prepayment certificate (PPC). The 12-month PPCs will remain at £108.10 and can be paid in instalments, meaning people can obtain all the medicines they need for just over £2 a week.
The NHS also has a low-income scheme, meaning that some will be eligible for help with prescription payments, and pensioners, students and those receiving benefits or living in care homes can access free prescriptions (DHSC, 2022). There is also £22 billion of funding available in 2022 to 2023 to assist with the cost of energy bills, which aims to help people save more of their money.