Transparency data

16 January 2020 minutes

Published 3 October 2022

Meeting details

The meeting was held on 16 January 2020 from 11am to 12:30pm in the boardroom (Sir Alexander Fleming), Association of the British Pharmaceutical Industry (ABPI).

The chair was Ben Osborn.

Minutes were taken by Michael Vidal.

Attendees

From the Department of Health and Social Care (DHSC):

• Liz Woodeson
• Matt Harper
• Daniel Law
• Andina Ward
• Richard Mattison
• Michael Vidal

From NHS England and Improvement (NHSEI):

• Gareth Arthur
• Laura Norris

Note: NHS England and NHS Improvement have worked together as a single organisation since 1 April 2019. NHS Improvement became part of NHS England in July 2022.

From the Association of the British Pharmaceutical Industry (ABPI):

• Ben Osborn (Pfizer, chair)
• Andrew Miles (GSK)
• Richard Torbett
• David Watson
• Ryan Hollingsworth
• Paul Catchpole
• Ramya Logendra

From the devolved administrations (DAs):

• Cathy Harrison (NI)
• Andrew Evans (Wales)
• Julia McCombie (Scotland)

Minutes of last meeting

The minutes of the last meeting held on 6 June 2019 were agreed.

On actions arising from the previous meeting, DHSC updated on follow-up work which had been undertaken with NHS Digital regarding their publication of medicine spend. The department, NHSEI and the ABPI all contributed to the public consultation carried out in the summer by NHS Digital on the future development of their prescribing costs publication. NHS Digital acknowledged that using only list price information did not provide a clear and true indication of medicine spend.

DHSC will be liaising with NHS Digital on their proposed approach to report actual medicine costs from Rx-Info’s ‘Define’ dataset. The intention is for this approach to be included in future publications, expected to be from spring 2020.

ABPI noted that this development was helpful and going forward ABPI hoped that future NHSEI and DHSC communications would be based on these contextualised figures.

Action

DHSC, NHSEI and ABPI to consider the tone of how future medicine spend headline numbers are communicated. ABPI and NHSEI to discuss methods to identify the more accurate spend and growth of branded medicines in England.

Scheme metrics

DHSC presented the scheme metrics, which were developed following discussion in the first operational review meeting in June. DHSC highlighted the metrics centred around technology appraisal (TA) processes, sales and scheme membership, as well as growth and payments.

DHSC made note of the number of new product launches, with a growing percentage of these being new active substances (NASs). This is coupled with the speed of National Institute for Health and Care Excellence (NICE) appraisals which continues to improve, with oncology appraisals especially, close to achieving their 3-month target.

DHSC mentioned that scheme membership had increased in 2020. Anticipated Q1 data should show a total of 195 members, 86 of which will be payment companies. DHSC will ensure this updated member information will be published on the department’s website in due course. This was welcomed by ABPI who felt this highlighted the strength of the 2019 voluntary scheme for branded medicines pricing and access (VPAS).

DHSC presented information on sales by scheme which illustrated overall sales and the gap between actual sales.

This led to discussion around how success should be defined – ABPI made a suggestion to include milestones for metrics. DHSC questioned whether it would be more appropriate to include all the relevant data then discuss at the operational meeting whether these areas can be defined as successes.

Action

Separate discussion on how success is defined. Agreement needed on whether there are appropriate milestones, what they might be, and how they might be incorporated into the metrics.

DHSC lastly presented voluntary scheme cumulative growth after payment. This illustrates the fluctuations evident in the scheme. ABPI indicated that it would be beneficial to include an additional line, specifying what the absolute actual growth rate was each quarter and annually, as otherwise, as presently presented, cumulative growth alone is open to misinterpretation.

Action

Separate discussion to also review the metrics and make final refinements to ensure the metrics are as meaningful and clear as possible. DHSC to include quarterly and annual growth rate data in next metrics slide pack.

In terms of price increase applications, ABPI also put forward the possibility of including the number of applications received, compared to the number granted. This would give a more comprehensive metric indication. There was some debate about how this inclusion would adequately measure success and would need further reasoned discussion.

ABPI also felt it was important to understand the progress made in improving the innovation ecosystem, and whether this could be easily measured using existing parameters to identify new innovative products not containing a NAS. All agreed that an informal discussion would be beneficial.

Action

Informal meeting between ABPI and DHSC operations team to consider other reporting categories for new non-NAS products.

NHSEI confirmed that, now the draft commercial framework has been published, it is considering the metrics for those elements of the scheme for which it is responsible. ABPI expressed their disappointment that these metrics are not yet fully defined.

Action

NHSEI to provide an update on these metrics by the next formal review.

Access update and outcome

NHSEI updated on NHSEI’s continued work on access, uptake and commercial arrangements.

Horizon scanning

Good progress has been made on a shared approach to horizon scanning. Work will continue through the commercial framework discussions, wider NHSEI and ABPI collaboration and the accelerated access collaborative (AAC).

Engagement

As well as the establishment of the commercial medicines triage function, NHSEI have been engaging with a number of companies through quarterly meetings, and to further strengthen engagement, the launch of commercial clinics to undertake deep dive analysis. The patient access to medicines partnership (PAMP) is now fully established with the next meeting to be held on 3 February.

Commercial arrangements

The draft commercial framework has been generally well received, the recent consultation has now closed, with publication planned for spring 2020. It is important to note that NHSEI have continued to negotiate commercial deals while the framework been put together. The scheme commitment for the commercial framework to set out an operational detail, including on escalation, was noted.

ABPI asked that future operational reviews should consider whether appropriate flexibilities were evolving as needed to allow access, and whether insights could be gathered and reported at an aggregate/anonymous level by NHSEI, ABPI and DHSC.

Uptake support

On 5 highest health gains (5HHG), NHSEI explained how initial work centred around developing a robust approach for identifying the health gain offered by different categories of medicines, using data from NICE technology appraisals (TAs) from the last 5 years. The scheme agreement to identify the 5 classes with the highest health gain and accelerate the uptake of these medicines to the upper quartile of comparator countries by June 2021 was noted.

A revised approach has since been undertaken based on:

• clinical opinion
• alignment with the priorities of the NHS Long Term Plan
• quality-adjusted life-year (QALY) gain
• population size
• cost effectiveness

Timescales are slightly behind plan, due to the importance of having a defensible approach.

The next phase in the process will focus on refining the list and measurement, alongside work on aligning NHSEI’s approach and AAC support, to ensure a consistent message is disseminated to stakeholders and industry.

ABPI recognised the complexity of the work NHSEI had undertaken on the categorisation process but expressed concern that this commitment may not be achieved within the agreed timelines.

While broadly welcoming the long list, ABPI expressed their concerns about the potential inclusion of generic medicines, which they felt would globally send out a negative message about how the UK prioritises innovation. ABPI also expressed that it would be unacceptable to include medicines in populations that were yet to be appraised by NICE, as products at pre-health technology assessment (HTA) stage would struggle to fulfil the upper quartile ambition by 2021 even if recommended in 2020. NHSEI acknowledged ABPI concerns and will provide an update at PAMP on 3 February.

Action

NHSEI to provide an update on 5HHG at PAMP on 3 February.

Medicines growth

ABPI summarised the key messages from the recent letter to Steve Oldfield. The main concern centred around the lower than anticipated growth and what factors were driving this.

Also, to remedy the disparity in forecast outcomes, a more collaborative approach to forecasting (which would also include NHSEI) was suggested.

There was all round agreement to work together to improve understanding of current outturn and future growth, though it was understood that the mechanics in the scheme will continue to automatically revise forecast growth as actual sales data is received.

Action

ABPI, DHSC and NHSEI to scope further forecasting work.

Operations update

DHSC gave a status report on the operation of the 2019 VPAS. 2019 Q1 to Q3 data showed an increase in VPAS payments from £197 million to £216 million on eligible sales.

Work is being undertaken to gather re-stated audited annual sales reports for 2018, stipulated under the 2020 VPAS. Currently around half-a-dozen audited sales reports remain outstanding, and those companies are being pursued.

For medium sized company exemptions, the allowance is applied in full at the start of a calendar year rather than spread across the year. This means lower payments from those companies at the start of a year with gradually increasing payments as the year progresses.

Three companies opted to continue to pay historic cash payments under the 2019 VPAS. The 2019 audited submissions for these companies are due to be with the department at the end of March 2020.

There are currently ongoing disputes, though DHSC are engaging with a few companies on varying policy and operational issues. DHSC hoped this initial mediation would mitigate any further dispute escalation.

Any other business (AOB)

ABPI queried developments around the innovative medicines fund. DHSC stated that preparatory work was underway, including on plans for consultation, and that there would be further details in due course. DHSC sought the opinion of ABPI on whether there should be a public consultation on the new fund and ABPI stated that it would like to see a public consultation undertaken.