Access to Hospital Pharmaceutical Markets in the United Kingdom

Publication Date	August 2008
Publisher	JustPharmaReports
Product Type	Article
Pages	81
ISBN Number	not applicable
Product Code	JPR00004

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Summary

Public hospitals represent a very important market segment for most biopharmaceutical companies in Europe. They are the often the only market for the increasing numbers of speciality drugs emerging from R&D, with many primary care products also unable to get established for maintenance therapy in the community without hospital recommendation first. Though the processes for achieving hospital usage are very different to the reimbursed GP/community pharmacy sector, they have been poorly documented and often little understood. This justpharmareports' publication aims to clarify the situation for the UK, a particularly challenging country with four different public healthcare systems, numerous stakeholders, regular reforms, and rigorous health technology assessment.

Medicines prescribed in English hospitals in 2006 were valued at £2.7 billion. This represented 24% of the English NHS drugs bill (hospital prescribing in London alone accounted for 40% of all prescribing costs in the capital). Even more significantly, the hospital drug bill has been rising at more than twice the rate of GP prescribing costs.

'Access to Hospital Pharmaceutical Markets in the UK' provides:

Comprehensive and clear information on how medicines for hospital use get selected, purchased, distributed, prescribed, dispensed and paid for.
Separate sections on England, Scotland, Wales and Northern Ireland.
Full coverage of the NHS plus two of the largest private providers.
Explanation of tendering, contracting, contract adjudication and other aspects of procurement for both brands and generics.
Clarification of the complex English funding system, Payment by Results.
Special focus on oncology.
What discounts hospitals expect and why value-added tax is a concern.
Features on risk-sharing schemes and on the boom in homecare services.
NICE, SMC, AWMSG, the PPRS and much, much more……………..

Content

1. Market Background
1.1 UK
1.2 National Health Service
    1.2.1 NHS England
    1.2.2 NHS Scotland
    1.2.3 NHS Wales
    1.2.4 NHS Northern Ireland
1.3 NHS Funding
1.4 Pharmaceutical Use
   1.4.1 Prescribing
   1.4.2 Costs
1.5 Strategic Implications

2. Managed Entry of New Drugs
2.1 Horizon Scanning
   2.1.1 Case Study: Anticancers
2.2 Formularies
   2.2.1 Hospital Formularies
   2.2.2 Area Formularies
2.3 Health Technology Assessment
   2.3.1 England: NICE
     2.3.1.1 Topic Selection
     2.3.1.2 Technology Appraisal Process
     2.3.1.3 Clinical Guidelines
     2.3.1.4. Manufacturer Submission
     2.3.1.5 Outcome
     2.3.1.6 Appeals
     2.3.1.7 Uptake
   2.3.2 Scotland: SMC
   2.3.3. Wales: AWMSG
   2.3.4 Northern Ireland
2.4 Strategic Implications

3. Procurement
3.1 Product Differentiation
3.2 Procurement in England
   3.2.1 NHS Bodies Concerned
     3.2.1.1 DoH Commercial Directorate
     3.2.1.2 NHS Supply Chain
     3.2.1.3 NHS Purchasing and Supply Agency
     3.2.1.4 National Pharmaceutical Supplies Group
     3.2.1.5 Pharmaceutical Market Support Group
     3.2.1.6 Collaborative Procurement Hubs
   3.2.2 Public Procurement Directive
   3.2.3 Contracting Process
   3.2.4 Good Practice Guide for Contracting
   3.2.5 London Procurement Programme
3.3 Procurement in Scotland
3.4 Procurement in Wales
3.5 Procurement in Northern Ireland
3.6 Strategic Implications

4. Product Selection
4.1 Price
   4.1.1 Brands
      4.1.1.1 PPRS
      4.1.1.2 List Price
   4.1.2 Generics
   4.1.3 Overall Market
   4.4.1 Price Comparator
4.2 Non Price Criteria
4.3 Parallel Imports
4.4 Unlicensed Medicines
4.5 Strategic Implications

5. Funding
5.1 England: Payment by Results
   5.1.1 Coverage
   5.1.2 Impact on Medicines
      5.1.2.1 NICE Adjustments
      5.1.2.2 High Cost Drug Exclusions
      5.1.2.3 Pass Through Payments
      5.1.2.4 Specialist Commissioning
      5.1.2.5 Chemotherapy
5.2 Other Countries
   5.2.1 Scotland
   5.2.2. Wales
5.3 Risk Sharing/Discounting Schemes
   5.3.1 Case Studies
     5.3.1.1 Disease Modifiers in MS
     5.3.1.2 Xolair in Allergic Rhinitis
     5.3.1.3 Velcade in Multiple Myeloma
     5.3.1.4 Tarceva in Lung Cancer
     5.3.1.5 Sutent in Renal Cell Carcinoma
     5.3.1.6 Erbitux in Colorectal Cancer
     5.3.1.7 Alimta in Mesothelioma & NSCLC
     5.3.1.8 MabThera in Follicular Lymphoma
     5.3.1.9 Lucentis in Wet AMD
5.4 Patient Copayment
5.5 Strategic Implications

6. Distribution
6.1 Prewholesalers
6.2 Wholesalers
6.3 Short-line Stores
6.4 Stock Diversion
6.5 Hospital Pharmacies
   6.5.1 Stock Control
   6.5.2 Inpatient Supply
   6.5.3 Outpatient/Day Care Supply
   6.5.4 Accident and Emergency Supply
6.6 Homecare
   6.6.1 Advantages
   6.6.2 Homecare Providers
   6.6.3 Services Offered
   6.6.4 Potential Antitrust Concerns
6.7 Strategic Implications

7. Private Sector
7.1 Private Healthcare Providers
7.2 Private Health Insurance
7.3 Case Studies
   7.3.1 General Healthcare Group
   7.3.2 HCA International
7.4 Strategic Implications

List of tables
1.1 Estimated expenditure on hospital medicines by country
1.2 Estimated cost of hospital prescribing by SHA, 2006
2.1 NICE decisions and cost per QALY
2.2. NICE and SMC on anticancers
3.1 Collaborative procurement hubs in England
3.2 Pharmacy purchasing groups
3.3 Example of typical contracting timetable
3.4 Responsibility for tendering by product/service type
3.5 Potential division of contracting arrangements in London
4.1 Phased price changes expected in 2009 PPRS
4.2 Risk assessment of unlicensed medicines
5.1 High cost drug exclusions from PbR, 2008-09
5.2 Pros and cons to NHS of risk sharing schemes
6.1 Products delivered by homecare companies, 2005
7.1 Leading private hospital groups