NHS May Use More "Stick" Than "Carrot" to Ensure Prescribing of Cheaper Biosimilars

The National Health Service (NHS) could begin to use its reimbursement system to incentivize hospital physicians to prescribe less expensive biosimilar medicines, according to NHS regional pharmacy procurement specialist Maggie Dolan, who spoke at a recent Medicines for Europe biosimilars conference in London.

The attendees at the conference heard that it is not concerns about the science of biosimilars that is holding back their adoption, but a lack of incentives for switching from reference biologics to their less-expensive alternatives.

Dolan said that in England the NHS is having trouble finding ways to share the savings generated by biosimilars among “purchasers” of healthcare and “providers,” the 2 elements of the NHS system. So-called gainshare agreements, in which savings generated by biosimilars are equally shared between the group purchasing the service (Clinical Commissioning Group, CCG) and the hospital providing it, have shown promise but in some cases the CCGs and hospitals have not been able to agree on gainshare agreements. The areas where there is no gainshare agreement are the areas where biosimilars are not being used, Dolan explained.

An example of successful uptake of biosimilars was discussed: University Hospital Southampton NHS Foundation Trust, where use of the infliximab biosimilar for infliximab (Remicade) for its gastroenterologic indications has cut almost a million pounds from the hospital’s annual budget. Southampton hospital achieved this goal by coordinating between patient groups, the manufacturer, and commissioners.

NHS authorities may choose to try and use the reimbursement system to force physicians to use biosimilars in hospitals that are not prescribing biosimilars, Dolan said. In the near future, drugs will be reimbursed at the price of the biosimilar, so using the branded drug would cause hospitals to accumulate large amounts of debt. “I think we are not very far away from seeing examples of just that kind of pressure being put on doctors,” she said. Hospitals are under intense pressure to balance their books. She said she believes the difficult fiscal situation facing NHS will mean less “carrot” and more “stick,” not necessarily overnight but over the next year as funding arrangements are reviewed across the country. She added that adoption of biosimilar rituximab may be affected by NHS’ decision to steer clear of a national gainshare agreement. NHS has decided to give a refund to hospitals that achieve target usage goals under the country’s Commissioning for Quality and Innovation national goals.

The “stick” approach to encouraging biosimilar adoption is being used in Denmark, according to Steinar Madsen medical director of the Norwegian Medicines Agency, who also spoke at the conference. Madsen said Danish authorities have made Denmark a leader in biosimilar use by threatening doctors with cuts to staffing and services if they don’t use biosimilars. Nearly all hospitals in Denmark use biosimilars, he said. Once the biosimilar to adalimumab becomes available, possibly next year, AbbVie’s Humira will “disappear” from the Danish market, predicted Peter Jorgensen, director of the Danish generics and biosimilars industry body.

In the United States, the idea of incentivizing physicians to prescribe biosimilars may be of interest, especially with a new administration anxious to cut healthcare costs. CMS, for example, could potentially put pressure on prescribers for millions of American patients covered through Medicare and Medicaid to more quickly adopt cheaper biosimilars as more are approved in the coming years.