Value trumps cost when getting the most out of spending on medicines. An HSJ Medicines Forum panel session, sponsored by Bial, discussed the obstacles to achieving the best value and what could be done to overcome them
This thought leadership piece has been funded by Bial. Bial has had no input on the content and has solely reviewed it for factual accuracy and compliance.
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After the workforce, medicine is the NHS’s second highest spend1. In 2023-24, the health service spent £20.6bn on medicines when not accounting for central rebates2, an increase of 7 per cent from £19.2bn the year before.
So, given the dire financial state the NHS is in – as of the end of August, integrated care systems were collectively £487m behind their financial plans3 – the pressure is on to show the health service is getting the most out of medicine for its money.
However, as discussed by an HSJ Medicines Forum panel – sponsored by Bial – this isn’t straightforward. For starters, the panel pointed out that the definition of what value is and how it should be measured can be ambiguous. Even when there is consensus about what metrics to look at, the necessary data could be missing entirely, tracked in an unhelpfully siloed manner, or split up into financial years, which did not always coincide neatly with the pharmaceutical commissioning process.
These feelings of fragmentation extended to formularies. The panel highlighted the plethora of formularies in place throughout England, adding some of the country’s 42 integrated care boards operated more than one. This has the potential to create problems when patients move care settings or providers, as they may suddenly find themselves unable to access their prescribed medication due to a different formulary – or even the same formulary being applied more strictly. This didn’t always represent what was best for the patient, the panel added.
Formularies may not always reflect reality either, with the panel citing an example of an ICB where two-thirds of patients being treated for a condition were on second-line medication. The panel said this disconnect between what happened in theory and what happened in practice made it difficult to assess the value of new medications.
Formularies were not the only area of ambiguity the panel had to compete with. They pointed to the range of issues being pushed back on under GPs’ collective action – HSJ has reported on GPs refusing to prescribe for severe mental health conditions, neurological conditions, and other long-term conditions4 – as a sign the GP contract was open to interpretation in parts.
But there are ways to overcome these challenges. On metrics, the panel discussed how automation could be used to pull the necessary data and operate databases for longer than otherwise viable. Secure data environments, although still in their infancy for most of the country, had the potential to co-locate currently siloed data, the panel added.
The panel also discussed ideas to improve formularies, including the possibility of a national formulary system. This would allow medicines to be assessed for their value just once rather than dozens of times over.
If a national approach wasn’t possible, the panel discussed the potential of ICBs working together regionally to agree on, for example, traffic light statuses. However, the panel stressed the importance of aligning to a clearly established common goal, citing an example of where a similar approach had failed because the region’s organisations had different aims.
Other ideas the panel explored for improving medicine value included: a closer collaboration between the NHS and industry to support the commissioning process and help commissioners understand each product’s value at the initial application stage; more engagement from pharma with NHS England to help shape the GP contract and the national direction on shared care; increased use of community pharmacies to improve access to medicines; and a renewed focus on de-prescribing so money wasn’t wasted on medications patients no longer needed.
Overall, panel members felt more work was needed to improve how value is measured for medicine spending. However, what was vital was not to bend to pressure to drop initiatives with the biggest long-term impact on value in favour of short-term cost-cutting – easier said than done in an NHS that is constantly firefighting.
Job number: UK/BIAL/2025/001
Date of preparation: February 2025
References
1 NHS England» Medicines Value and Access [Internet]. www.england.nhs.uk. [Cited 2 December 2024] Available from: https://www.england.nhs.uk/medicines-2/medicines-value-and-access/
2 Prescribing Costs in Hospitals and the Community - England 2023-24 | NHSBSA [Internet]. Nhsbsa.nhs.uk. 2023. [Cited 2 December 2024] Available from: https://www.nhsbsa.nhs.uk/statistical-collections/prescribing-costs-hospitals-and-community-england/prescribing-costs-hospitals-and-community-england-2023-24
3 NHS England» Financial performance update [Internet]. www.england.nhs.uk. 2024. [Cited 2 December 2024] Available from: https://www.england.nhs.uk/long-read/financial-performance-update-oct-2024/
4 Tilley C. Emergency prescribing and “shared care” withdrawn by GPs [Internet]. Health Service Journal. 2024 [Cited 3 December 2024]. Available from: https://www.hsj.co.uk/primary-care/emergency-prescribing-and-shared-care-withdrawn-by-gps/7038206.article
