Transcript Update “What is happening in the medicines homecare market?”

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Update
“What is happening
in the medicines
homecare
market?”
Allan Karr, MRPharmS, DipM, MBA.
Chairman, National Homecare Medicines
Committee
Allan Karr, MRPharmS, DipM, MBA.
Chairman, National Homecare Medicines Committee
Medicine Homecare Services
Aim is to :
“Support patients with
chronic and acute illnesses
in the community.”
Medicines Supply Chain
Homecare
delivery service
Production
EMEA
unit
R&D
Manufacturer
MHRA
Original patent holder
Production
unit
Specials
Manufacturer
EMEA
Generic
Supplier
Distributor & Wholesaler
Production
unit
Ward
Hospital
pharmacy
Patient
Community
pharmacy
MHRA
PI
Supplier
Dispensing
doctor
Homecare Service Process
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Consider product and type of service – obtain approval e.g. DTC, PCT’s
Methodology for recruiting/registering patients
Prescription process e.g. clinical check, chasing Rx
Agree performance standards with provider
Contract with Homecare services provider
Communication process between all parties
Home care company can then provide the service
e.g. purchase, dispense, deliver and administer medicines.
General/Value added e.g. Collection of waste, education and support.
Data management, Training, Clinical Governance & Audit
Invoice and Payment
Monitor and audit performance
Risk Management Potential
Increasing Risk
Preparation
Aseptic
& Increasing Cost
& Increasing Complexity
Delivery Process
Nurse
Administration
Nurse
Administration
Dispensing
Process
Dispensing
Process
Dispensing
Process
Delivery Process
Delivery Process
Delivery Process
Increasing value added service
Existing Therapeutic Areas
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Cardiology
Oncology
Cystic fibrosis
Dermatology
Gastroenterology
Haematology
Haemophilia
HIV
Hypopituitarism
Lyposomal storage disorders
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Multiple Sclerosis
Post-menopausal Osteoporosis
Primary Immunodeficiency Disease
Renal dialysis and transplant
Schizophrenia
Respiratory disease
Rheumatoid arthritis
Rheumatology
Thalassaemia
Current medicinal products that have
been supplied via Homecare Services
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Home parental nutrition
IVF Treatments
Adult growth hormone
Milrinone
Trastuzumab
Epoetin
Anitbiotics
Etanercept
Efalizumam
Methotrexate
Adalimumab
Imiglucerase
Epoetin
Blood coagulation factor VIII & IX
Anti-retrovirals
Somatropin (human growth hormone)
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Desferrioxamine
Interferon
Beta-interferon
Topotecan
Teraparatide
IV/SC immunoglobulin
Darbepoetin
Immunosuppressants for renal transplant
Clozapine
Terbutaline
Adalimumab
Infliximab
Teraparatide
Methotrexate
Desferrioxamine
Herceptin
Market Size & Growth
• Market Size £960m
• Market Growth +18% pa
Continence
£45m
Diabetes
£59m
Other
Growth H.
£68m
Haemophilia.
£53m
MS
£31m
Cystic
Fibrosis
£30m
£39m
Stoma
£150m
Pharma
Med
Consumables
£241m
£300m
Urology
£85m
Nutrician
£180m
Fluids
£200m
Source:
Overall Market & Growth: AT Kerney Market Data, Provider Revenue & Growth Estimates, DHL commissioned
Therapy Split: DHL Commissioned Primary Research, Provider & Pharmaco Revenue Data
Insulin
Pumps
£20m
Current List of Homecare Providers
Air products
Calea Uk
Careology
Flexible Home Care
Health Care at
Home/ADS
Intecare
Nutricia Clinical Care
Bupa/Clinovia
Polarspeed
Mawdsley Brooks
Baxter/Willow
Medco
Central Home Care
(Alliance Unichem)
Evolution
(AAH/Celesio)
DHL
What are the benefits
of Medicines Homecare
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Organisation
Discharge patients sooner
Reduce non-essential OPD appointments & admissions
Moves workload from dispensary to administration
Reduced waiting times
Financial?
Patient
Increased choice
Time saving - no waiting in OPD
Reduced travel
Convenience
Quality of life – less hassle
Less risk of HCAI
Pharmacy
Capacity gains
Reduces stress in the dispensary
Refocuses skill mix and clinical priorities
Reduced waiting times for non-home care patients.
Primary care
Policy
Capacity
Efficiency
Control
Patient choice
Financial
Benefits/Drivers
Pharma Industry Perspective
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Company is closer to the patient.
Increase opportunity for DTC marketing?
Fewer control systems?
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Ability to offer reduced prices to customers
without loss of profit e.g. part of NICE
“patient access scheme” process.
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More control over the supply chain
The Procurement Framework
and Contracting Models
1. Host Trust Tender Model
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Trust selects the service
Specification developed and tendered
Trusts selects a preferred provider
2. Pharma Company Model
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Pharma tender or selection
New distribution route
No NHS involvement
Models of Distribution
Relationship?
No Tendering
Tendering
Relationship?
No Tendering
Hospitals/
PCT’s/CPH’s
Pharmaceutical
Manufacturers
Homecare
Supplies
Hospitals/
PCT’s/CPH’s
Tendering
Homecare
Supplies
Pharmaceutical
Manufacturers
The Governance and Quality Issues
- with outsourcing comes risk
Services are not the same as products e.g.
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Absence of inventory from trust perspective
People as part of the service
Greater involvement of customers
Greater difficulties in maintaining quality standards
Importance of time factor
The Governance and Quality Issues
- with outsourcing comes risk
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Prescription checking and validation
Aseptic preparation and administration
Technical and clinical advice
Responsibilities and liabilities of each party
Performance standards
Error and complaint monitoring
The Clinical Governance Framework
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Risk management
e.g. assessment and risk reduction techniques
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Establishment of quality systems and
performance standards
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Inclusion in Trust Clinical Governance procedures
Must have a clear contractual relationship
between purchaser & provider
What are the Outstanding Issues?
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NHS strategy e.g. private sector, do-it- yourself (OPAT), FP10(HP)?
Confirmation/clarity on VAT position
Agreed product list for home care
Ensure adherence to professional practice & Clinical Governance.
Operational systems need improving e.g. employing home care
co-ordinators, electronic links with home care suppliers.
Data management
What are the Outstanding Issues?
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Clarification of PCT/GP/Commissioners role
Fit in new financial structure e.g.Tariffs, Financial resources
Relationship between manufacturer, home care service
provider and Trusts
Managing a contracted service effectively
Development and use of common contracts
Development of performance standards & audit arrangements?
Unbundling of costs from products
What are the Outstanding Issues?
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What will be the impact of new home care services suppliers
Recognition that the home care market exists and is becoming more
important
Role of the National medicines
Homecare Committee
Hospitals/PCTs/CPH’s
NHMC role
Effective Working
Relationships
Pharmaceutical
Manufacturers
Home Care
Supplies