NHS best value biological medicines framework
Biological medicines, including biosimilar medicines, play an important role in healthcare, opening up many possibilities for the treatment of disease and illness. With some widely used biological medicines due to lose patent protection between now and 2028, NHS England has a substantial opportunity for early and widespread adoption of better-value versions, which could free up to £1 billion in savings to reinvest in patient care.
Commissioning framework
Some eight of the top ten medicines prescribed in NHS hospitals by spend are biological medicines. These medicines are used to treat a range of conditions from cancer to chronic inflammatory conditions such as rheumatoid arthritis and inflammatory bowel disease.
NHS England's horizon-scanning data identified that the NHS spends approximately £1.4 billion on biological medicines that are due to come off patent between now and 2028. This presents an opportunity to secure up to £1 billion in potential savings through the timely uptake of best-value biological medicines once they are launched.
NHS England has prioritised switching for the following five biological medicines, based on volume of patients across primary and secondary care, value (scope for efficiency savings), opportunity for patient optimisation in the pathway, and potential complexity of a switch.
| Biological medicine | Disease area | Spend in 2023/24 |
|---|---|---|
| Ustekinumab | Crohn's, psoriatic arthritis, ulcerative colitis | £210 million |
| Aflibercept | Eye disorders | £300 million |
| Ocrelizumab | Multiple sclerosis | £120 million |
| Ipilimumab | Cancer | £70 million |
| Vedolizumab | Ulcerative colitis, Crohn's | £190 million |
Thanks to advanced engagement and preparation with clinical teams across the NHS, biosimilar versions of ustekinumab – the first molecule in the best-value programme – now make up 95% of prescriptions dispensed following loss of patent protection. This is significantly ahead of other European countries.
The NHS hopes to achieve similar results when aflibercept – the next of its five identified molecules, which treats wet macular degeneration – loses patent protection. Currently the NHS spends nearly £1 million a day on the originator prescription.