The work described here was presented at the Pharmacy Together 2019 conference.
A commissioning framework for biologics was published by NHS England to support faster and more effective uptake of best value biological medicines. The pharmacy team at a teaching hospital in the North West took this opportunity to plan and facilitate the switching process with the aim of producing a beneficial impact on medicines optimisation.
A project plan was developed and approved by the Trust Medicines Governance Committee and the switch commenced on the date suggested by NHS England. This did not require ethics approval. Patient consent letters were sent four months prior to the switch so that patients were given an early opportunity to discuss any concerns. Management of stockholding of branded and biosimilar products was planned in advance with the pharmacy procurement team and out-patient dispensing partner. A service level agreement was agreed with the contracted homecare company and follow up letters were sent to patients confirming the final biosimilar product one month before the switch.
Define software is used to monitor and analyse medicine usage monthly. The pharmacy dispensing system is also used to generate a more detailed dispensing report on a monthly basis and identify any anomalous prescribing. Reports are presented to the clinical team as regular feedback. There is on-going engagement with the clinical team to monitor effectiveness of the new biosimilar product.
Early identification of a pharmacy lead for the project, and early and ongoing engagement with all stakeholders are keys to success
All patients who have been switched remain clinically stable and no adverse effect has been reported. The switch also results in significant savings to the health economy. This enables the NHS to maximise the value for patients from the amount it spends on adalimumab and allows much needed headroom for funding innovative treatments and/or improvements in pathways of care.
The ambition set by NHS England of “90 percent of new patients being on the best value biological medicine within three months of product launch and 80 percent of existing patients within 12 months” has been achieved. Results show that there was an uptake of biosimilar adalimumab of 75 percent in the first month, 88 percent in the second month and 97 percent in the third month, whilst the national average uptake is 23 percent after three months across the North West region. The outstanding 3 percent was down to patient allergy and clinical decisions.
There are a number of actions that positively contributed to the successful switch programme of biosimilar adalimumab. Early identification of a pharmacy lead for the project, and early and ongoing engagement with all stakeholders are keys to success. A robust oversight of stock management also has a positive impact on biosimilar uptake. From this project, we have identified that it may have been beneficial to develop the project plan at an even earlier stage.
Gareth Price and Jane Holyoak, Lancashire Teaching Hospitals NHS Foundation Trust, Preston.
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Competing interest statement:
The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.