Generic prescribing of immunosuppressant medicines contributes to QIPP programme
When GPs prescribe a medicine by brand name the pharmacist can dispense only that brand. The price of branded medicines is fixed until the original patent expires, when other manufacturers are free to introduce their own “generic” equivalents and compete on price.
Immunosuppressant medicines are prescribed for long-term treatment of organ transplant patients. They are critical medicines that prevent organ rejection post transplant, by suppressing the patient’s immune system.
London NHS organisations’ expenditure on immunosuppressants across primary and secondary care was in excess of £50m in 2011 but recent patent expiries have resulted in several generic alternatives becoming available at significantly lower cost.
The generics have been shown to be therapeutically equivalent to the original brand but switching patients to generics has to be carefully managed as bio availability may vary from manufacturer to manufacturer. It is important to make certain that, once the treatment of any one patient is changed to one of the generic medicines, it is continued with the same one.
The LPP MOPP workstream has engaged extensively with clinical stakeholders on managing the introduction of generic immunosuppressants across London. Clinical consensus on how best to treat patients was agreed including repatriation of patients currently on GP prescribing to secondary care to ensure close monitoring of patients during the transition. Once stabilised, patients have the option of receiving Consultant-prescribed immunosuppressants via a homecare delivery company.
A good example of potential savings is the change in market share across London NHS trusts between Prograf (branded) and Adoport (generic). Advagraf is a once daily preparation. The outcome so far is a reduction in market share held by Prograf®, the original branded product, from 88% to 27%, with a corresponding potential cost saving equivalent to £10 million p.a.
QIPP (Quality, Innovation, Productivity, Prevention) is a Department of Health large scale transformational programme for the NHS improving the quality of care the NHS delivers while making cost efficiency savings. The LPP MOPP Immunosuppressant initiative contributes significantly to the QIPP programme as follows:
Hospital specialist clinician prescribing ensuring that patients receive the most appropriate brand of immunosuppressant at the correct dose for the duration of treatment.
Service redesign where patients have their immunosuppressants delivered to their home at a date and time convenient to them.
Secondary care procurement of generic immunosuppressants allows discounts of up to 90 per cent compared to the equivalent branded price in primary care. This will save London NHS organisations over £10 million per annum including repatriation and monitoring costs.
Ensuring patients receive the correct brand of immunosuppressant significantly reduces the chances of organ rejection and helps to assure their quality of life. This will result in better patient care and minimise the likelihood of the need for costly re-transplantation and associated morbidity.
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