Some clinical commissioning groups (CCGs) could be missing important opportunities to maximise efficient use of Payment by Results Excluded (PbRE), high cost drugs, partly through a lack of expertise in secondary care prescribing.
Some clinical commissioning groups (CCGs) could be missing important opportunities to maximise efficient use of Payment by Results Excluded (PbRE), high cost drugs, partly through a lack of expertise in secondary care prescribing.
Approximately 60% of all medicines used in secondary care are PbRE drugs. Cost growth associated with PbRE drugs is increasing year on year (up to 20% per annum in some trusts). However, as the costs are usually passed directly to commissioners there is currently little incentive for providers to implement resource-demanding cost-saving schemes for these drugs. So what’s the solution?
We have been working with a number of commissioners on medicines optimisation reviews for PbRE drugs. While in most cases there are good procedures in place, important gaps can allow unplanned increases in the cost of drugs and there are some common themes emerging:
· In some cases, horizon scanning to inform annual contractual negotiations is limited, reducing commissioners’ ability to plan for cost pressures and drive potential efficiencies. Where we have identified a gap we are working with commissioners to implement regular ‘Confirm and Challenge’ meetings with clinicians to challenge budget planning assumptions, review patient pathways and identify opportunities for efficiencies.
· As highlighted in several recent reports, data quality associated with high cost drugs use is a significant issue for some commissioners. We have implemented a standard minimum data set to ensure that the data provided gives commissioners the information they need to understand what they are paying for.
· Despite some Trusts supplying effective data to allow analysis of medicines use and costs, some commissioners do not have sufficient in-house knowledge to raise contract queries, such as incorrect charges or unwarranted variations. A more robust approach to review of data and reporting is essential in ensuring charges are appropriate.
· A more thorough assessment and review of PbRE medicines use, such as dosage and pricing, can identify opportunities for savings as can carrying out annual reviews of drugs approved by Individual Funding Request to ensure they are still appropriate.
· Implementation of prior approval systems can support a more consistent and rigorous assessment process for the use of high cost drugs. These systems also offer wider benefits through the provision of more detailed financial information and a reduced risk of Information Governance breaches compared to paper based systems.
On the whole, CCGs tend to have a much greater level of knowledge and expertise in primary care medicines optimisation, while in-house knowledge and expertise to manage secondary care medicines is less common. One of the most successful ways we have seen of plugging that knowledge gap is through the funding of a pharmacist who is embedded within the local Trust. Working for the commissioner but within the Trust environment, the embedded pharmacist is ideally placed to promote and support local efficiency schemes.
In addition, working in partnership with the local Trust to incentivise effective management of high cost drugs where additional work is required to implement a scheme result in greater efficiencies.
Despite the disconnect between the prescribing body and the organisation responsible for picking up the tab, there are ways to optimise your secondary care medicines use. With the increasing pressure the NHS is under, can you afford not to?
