Reducing NHS Spending: How We Identify Cost-Effective Brand Switches For ICBs (Previously CCGs)

-by Veerle van Leemput & Greg Mills, Managing Directors at Analytic Health

How we help to identify cost savings for Clinical Commissioning Groups of the NHS, by demonstrating value-adding propositions for pharmaceutical companies.

Prescribing is the most common patient-level intervention in the National Health Service (NHS). The spend on prescribing in England in primary care was £9.5 billion in 2021 and has been rising year on year¹. This growing cost burden on the NHS makes it increasingly important that savings are found where possible. One common and relatively straightforward approach to saving money is by switching patients from one branded medicine to a lower-priced, bioequivalent alternative brand.

In this blog, we will share the approach that we use at Analytic Health, where we developed a Clinical Commission Group (CCG) cost savings feature in our Pharmly Analytics² web application.

Clinical Commissioning Groups

A Clinical Commissioning Group, or CCG for short, is responsible for commissioning hospital and community NHS services in the local areas that they serve³. All GPs belong to a certain CCG. As mentioned in one of our previous blog articles, the NHS is undergoing restructuring. Over time, CCGs have been merged to cover larger areas and currently, there are 106 active CCGs in England.

Each CCG has a local formulary; a list of medicines that have been approved for use within their area⁴. Ultimately this defines which medicines GPs will prescribe. This makes CCGs a collective organisation that can be approached to change prescribing habits in its GP practices.

The Switch To Integrated Care Boards

As said previously, the NHS is undergoing restructuring and this restructuring goes further than merging CCGs. The Health and Care Bill⁵ sets out plans to put Integrated Care Systems (ICSs) in place. Each ICS will be led by an NHS Integrated Care Board (ICB), an organisation with responsibility for NHS functions and budgets. From the 1st of July 2022 onwards, CCGs will be absorbed by Integrated Care Boards (ICBs).

At Analytic Health we are well aware of the changes that will be happening, and from the 1st of July 2022 onwards we will not talk about CCG Savings anymore, but about ICB Savings. The wording changes, but our calculations and aim stay the same.

Whether we’re talking about CCGs or ICBs, the principle of cost savings by switching to other medicine brands does not change. GPs belong to a wider organisation with a formulary that plays a big part in prescribing habits and changes to this formulary can reduce cost burdens on these organisations.

Our Aims

Now we know a bit more background about the organisations GPs belong (or will belong) to, we can dive into our CCG Savings feature. Let’s start with our aims.

With our CCG Savings feature we aim to achieve three things:

1. Identify the CCGs that would save the most money by switching a portion of their prescriptions to a company’s brand and away from more expensive brands by other companies within the same product range. Hereby we contribute to realise savings to the health economy as a whole.
   
2. Calculate the additional revenue that would be generated for a medicine supplying company, following the prescription switches. This will incentivize pharmaceutical companies to engage with CCGs and demonstrate their value-adding proposition.
   
3. Identify the optimal set of General Practices (GPs) within the CCG that could help to reach the desired level of prescription switch. This limits the total number of GPs that need to be approached to make the switch and increases the likelihood that the desired level of switching is achieved.

The Data

To achieve all of the above, we need data. We identify potential CCG savings by analysing prescribing data. This prescribing data contains information about the number of prescriptions written in each English GP practice. Each GP practice belongs to a CCG, so subsequently, this data gets grouped to CCG level to determine prescriptions written throughout the CCG.

Below you can find some details on the data that is being used:

• Source: English Prescribing Data (EPD)
• Countries included: England
• Update frequency: monthly, on the day after the NHSBSA release the latest prescribing data we process the data and update any calculations depending on that data

Cost-Effective Brand Switches

To identify cost savings we look at potential brand switches. With brand switches, we mean that we suggest replacing prescriptions for a set of brands (E.g. B1) with prescriptions for a cheaper brand (E.g. B2). Brand switches can be relatively straightforward because we only suggest a brand switch to a brand with the same active ingredient, dosage form and therapeutic area. This aids the confidence in making the switch while not compromising patient care. That being said, we advise to always support brand switch suggestions with the approval of a clinical expert.

Our algorithm aims to identify which GPs should switch brands, and the quantity of prescriptions they should switch. We do this based on the maximal feasible switch quantity. In our algorithm, individual GP practices are requested to switch a maximum of 80% of their prescriptions (of the more expensive brands B1) to brand B2. The 80% limit was set as it has been established to be unrealistic to expect 100% of patients to be suitable for switching brands or to accept the new brand. We will discuss this later in the limitations section.

So how does it work? Let’s take a look at a simple demo example:

• GPs in London CCG prescribe 100 units of brand B1 and 10 units of brand B2, each month.
• Both of these brands are part of the same product range (the same active ingredient, dosage form and therapeutic area (BNF sub-paragraph) combination).
• These 110 units are prescribed in 5 GP Practices.
• Brand B1 is expensive and costs £1.00 per unit.
• Brand B2 is cheaper and costs £0.40 per unit.
• The total monthly cost for the CCG is (100 * £1.00) + (10 * £0.40) = £104.00.
• Let’s say we want to switch 60% of their prescriptions (of the more expensive brand B1) to brand B2.
• 60% of 100 = 60 units. Our smart algorithm identifies the optimal set of GP Practices to reach the target of switching 60 units.

• GP Practices A and B have been identified to, combined, achieve the target switch of 60 units.
• GP Practices C, D and E do not need to be contacted or change their prescribing behaviour.
• The CCG will save £0.60 per unit, so 60 units * £0.60 = £36.00 per month (a reduction of 35% compared with their original monthly cost of £104.00).
• As 60 additional units of brand B2 will be prescribed: 60 units * £0.40 = additional revenue for brand B2 of £24.00 (an increase of 380% compared with the original monthly revenue of £4.00).

Creating Win-Win Situations

From the example above it is clear that CCGs can save money while at the same time allowing pharmaceutical companies to identify value-adding opportunities. This is a win-win situation for both parties. Furthermore, if CCGs can save money on legacy medicines by switching to another cheaper brand, they also have more budget available to invest in innovative medicines that pharmaceutical companies have to offer. Overall this can improve patient care.

Limitations

Unfortunately, as discussed earlier, not all potential savings can be achieved and there can be multiple reasons for this:

1. It is not possible to switch all patients to the proposed brand because sometimes there is a clinical justification for a specific patient for a specific brand.
2. Changing between brands may cause patient concern, thereby limiting their willingness to switch brands.
3. The administrative burden on GPs, that comes with changing prescriptions, may be too high compared to the potential cost savings for that specific GP.

All these reasons contribute to our decision to set the maximum achievable switch percentage per GP practice at 80%.

Pharmly Analytics

Our algorithm does all the hard work, and we nicely display the results of this algorithm in our web application: Pharmly Analytics.

Pharmly Analytics provides access to UK pharmaceutical market intelligence. The web application contains analyses for all the main healthcare datasets and has the option to build customised market views in the AI Console. In this AI Console, we help users to identify opportunities for their current and future product portfolio, ranging from green initiatives to brand optimisation, suggested product launches and potential CCG savings for selected brands.

The CCG Savings section of Pharmly Analytics enables the user to choose from any of their company’s brands. The user can view the analysis for any one of the CCGs that prescribe the product range related to the chosen brand.

There are a variety of inputs that can be used to model the switch over a variable number of months, beginning from a user-defined month – all based on your company’s capacity to supply the increased quantities and the estimated behaviour of the GPs within the CCG.

We know that sounds exciting! Are you part of a pharmaceutical company and eager to find out which CCGs can save money by switching to your brand? Or are you a representative of a CCG that wants to identify potential cost savings for your GPs? We’re more than happy to talk about what Pharmly Analytics can mean to you. Simply book a meeting with us and we’ll make it happen!

Feedback Or Questions?

Do you have any feedback or questions about this blog article? Feel free to reach out and we’re more than happy to discuss the content of this article in further depth.

Resources

¹ https://www.nhsbsa.nhs.uk/prescription-data/prescribing-data/english-prescribing-data-epd

² https://analytichealth.co.uk/pharmly-analytics/

³ https://www.england.nhs.uk/ccgs/

⁴ https://www.cnwl.nhs.uk/patients-and-carers/information-about-medicines/formulary

⁵ https://www.gov.uk/government/publications/health-and-care-bill-factsheets/health-and-care-bill-integrated-care-boards-and-local-health-and-care-systems