the cancer collaborative hosted a webinar on June 19 2019 with jatinder harchowal from the NHS whereby he provided insight into the NHS’ experience implementing biosimilars in oncology. jatinder spoke during the webinar about the work that was done in england and the opportunity they had to create system-wide change with key stakeholders to optimize biosimilar uptake and take advantage of the cost savings that were then reallocated, directly or indirectly back into the healthcare system.  the NHS has had experience with the introduction of the biosimilar rituximab, more recently with the biosimilar trastuzumab and is now introducing biosimilar adalimumab.

interestingly, the NHS launched a non-promotional pharma challenge through the cancer vanguard – to seek true partnership with industry to create an opportunity to make a change and drive some efficiencies in healthcare. 40 project proposals were received.  sandoz was ultimately selected to partner with the NHS to create a central repository that supported real-time advancement and to fast track the process of introducing biosimilars across three major hospitals, utilizing the expertise and resources of stakeholders.

since their introduction, there has been much more confidence with biosimilars and 90% of new patients are prescribed best value biological medicine within three months of launch. potential savings doubled from the originally projected 200-300£ to 400-500£.

– policies were developed that could be introduced across the country- quickly and locally with local incentives that would enable greater uptake.
– stakeholders were engaged from the beginning of the process and included multiple stakeholders [clinical, haematologist, pharmacy, nurses, patients, purchasing, formulary, e-prescribing trusts. drugs & therapeutics committee, finance sign-off professional groups, ESMO, BOPA commissioners, local and national [NHSE] developed incentives].
– easily accessible information was made available across the country including a biosimilar adoption process timeline and this ensured the replicability of the approach.
today, the NHS is getting smarter with uptake and within 6 months there has been a 98% trastuzumab biosimilar uptake [100M£ savings]

here are some key takeaways from that conversation to consider as canada looks to introduce biosimilars in oncology
1- using a system wide approach and national alignment to introduce biosimilars in oncology
2- having a multi-stakeholder approach which includes industry will be critical to the success of uptake in biosimilars. stakeholders are critical to the process.
3- the patient group voice will be instrumental in building confidence with patients [in the NHS example patient groups were involved from the start, were listened to, materials were co- produced with patient groups and were included in decision making].
4- savings must go back into the healthcare system, and shared incentives with hospitals to reinvest back into services and therapies. transparency as to how the savings will be reallocated. this is an extremely important consideration – if patients are not clear how savings will be reinvested into the system they will be more dubious about it.  patients in the UK, who were part of the implementation process were delighted to help the NHS save money.
5- having a central repository of information, avoiding repeating work and thinking about how we can share work.

*to note the collection of real world evidence is also be important.

there is much we can learn from the success of the NHS. rather than reinvent the wheel to create a canadian process, we can translate what has already been done but taking into consideration the nuances of each province to create a fair and favourable environment that will allow us to benefit from the introduction of biosimilars into our healthcare system.