NHS Prepares for October 2018 Arrival of Biosimilar Adalimumab

The United Kingdom’s National Health Service (NHS) has begun to prepare provider trusts and commissioners for the advent of biosimilar adalimumab. In a briefing to regional committees on the use of best-value biologics, the NHS urged commissioners to begin planning to use the best-value adalimumab option beginning in October 2018, when Amgen’s EU-authorized biosimilar, Amgevita, becomes available.

According to the briefing, the reference adalimumab, Humira, cost the NHS over £333 million (approximately $469 million) to treat approximately 57,000 patients with home-administered subcutaneous injections from 2016 to 2017. The NHS hopes that using the adalimumab product that provides the best value to the system will help it to achieve its 2021 goal of producing an annual savings of £200 million to £300 million (approximately $282 million-$422 million) through increased biosimilars use. The brief says that, in the current financial year, using other approved biosimilars has saved the NHS £170 million (approximately $239 million).

The NHS has established a working group to provide oversight of implementing the use of best-value adalimumab using a commissioning framework launched in September 2017. The framework proposes that at least 90% of patients new to treatment and 80% of patients currently receiving treatment be prescribed the best-value biologic within 12 months of the launch of a biosimilar. Both new and existing patients must sign a consent form if they are to be prescribed a biosimilar.

The working group reports that, because biosimilar adalimumab will be used primarily in rheumatology, gastroenterology, and dermatology indications, and the NHS has already gained experience in transitioning to biosimilars for infliximab, etanercept, and rituximab in these same indications, it can apply lessons learned to efficient implementation of the best-value adalimumab.

Regional Medicines Optimisation Committees are currently ensuring that commissioning plans are in place across England, providing focused attention to any barriers to implementing those plans and identifying the need for focused commissioning guidance, in addition to other tasks.

Furthermore, the South West Clinical Senate has undertaken a review of whether the NHS should prioritize a transition to biosimilars, commissioning support units are determining which regions will need additional tools to support transition, an internal dashboard for NHS will be used to record biosimilar uptake across regions, work with patient groups on education is under way, and a procurement strategy is being developed.

The NHS has had considerable success with biosimilars in recent years, with 80% of infliximab-treated patients and 58% of etanercept-treated patients receiving a biosimilar. However, uptake has been uneven across the nation; according to the NHS’ commissioning framework, 2 sample NHS trusts, both located in London, had biosimilar uptake levels of 25% and 99%. This difference in rates, said the NHS, demonstrated a “significant opportunity” to improve uptake and produce cost savings.