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NHS guide to unlock biosimilar savings is critical step in ambition for UK to be a world leader
By Robert Russell-Pavier, Economics Director, Medicines UK
In the first day of Sir Jim Mackey's role as interim CEO of NHS England, he wrote to all NHS providers stating that they must cut their cost growth in half within the next 9 months. The recent launch of NHS England's Commissioning framework for best value biological medicines is then very timely, and has the potential to make a significant contribution.
With "8 of the top 10 medicines prescribed in our hospitals by spend (being) biological medicines", the document serves as an important guide to help ICBs and hospital trusts act quickly to make financial sav-ings and widen access as biologic medicines come off-patent over the next four years. NHS England says that this could unlock £1 billion in savings in this time; that's £24m in highly achievable savings per ICB.
Biosimilars are similar in concept to generics but they are biologic medicines, which are complex molecules derived from living cells. With biosimilars being more nascent than generics, the NHS has employed a more precautionary approach to switching. Yet, with over a decade's experience, the MHRA as the UK's medi-cines regulator is now clear that biosimilars can be used interchangeably.
Therefore, NHS England is tightening its ambitions so that following biologic patent expiry with the onset of biosimilar competition:
- "100% of new patients requiring biological medicines will be initiated on the best value biological, where clinically appropriate, within 3 months following its launch";
- And, "at least 80% of existing patients will be on the best value biological medicine within 10 months of its launch".
In particular, NHS England has highlighted 5 biologic medicines losing patent protection over the next 3 years which collectively the NHS in England spent £900m on in 2023/24. They are:
| Biological medicine | Disease area | Spend in 2023/24 |
| Ustekinumab | Crohn's, psoriatic ar-thritis, ulcerative colitis | £210m |
| Aflibercept | Eye disorders | £300m |
| Ocrelizumab | Multiple sclerosis | £120m |
| Ipilimumab | Cancer | £70m |
| Vedolizumab | Ulcerative colitis, Crohn's | £190m |
For these medicines, we are delighted to see that NHS England will lead a nationally-coordinated planning and communications approach to support switching at scale and at pace. Indeed, with Ustekinumab being the first to have lost patent protection of this cohort, it's great to see a 74% uptake of biosimilars within 5 months.
It is also critical that NHS England has announced a nationally set payment for all patients treated with the biological reference product or biosimilar, which will include costs for the delivery of additional clinical ca-pacity required to facilitate a switch.
This means that for those providers that switch patients to more affordable alternatives, they will be able to retain the margin for use in local services. This cleverly borrows a lever from the reimbursement of un-branded generics in primary care, which in large part explains why community pharmacy generic prescribing and dispensing was at 80% in 2023/24.
There's still more to be done. Our analysis based on IQVIA data show that there are a handful of other higher value biologics losing patent protection (NHS sales over £20m) over the next 3 years, where a similar push and greater market clarity could be brought to bear.
However, when one links this uptake direction and funding incentives with last week's update from the MHRA that new UK national biosimilar licences will be granted within a 150 days, the UK is living up to its ambition to be a world leader in the use of biosimilars.
ENDS
For further information contact Jeremy Durrant on 07879 650206 or email jeremy.durrant@medicinesuk.com
For more information on Medicines UK, visit: www.medicinesuk.com/.