Norway is an elongated and scarcely populated country 5,1 million inhabitants 4 health regions 21 Health enterprises 80 Hospitals
Drug procurement cooperation - LIS Drug procurement cooperation organization Drug procurement cooperation results Drug procurement cooperation Key success factors
Drug procurement cooperation Established January 1995 6 employees administrates 7 400 contracts for 2015
The purpose of the Drug procurement LIS-regulations - 1 cooperation (LIS) is to prepare the basis and specifications for purchase and delivery agreements of pharmaceuticals in cooperation with the state owned hospitals, and thereby reduce the costs.
Participants in LIS and the annual fee All health regions and all public hospitals in addition to Lovisenberg and Diakonhjemmet. Each participant pays an annual fee for operation of the LIS. The annual fee is distributed among the participants in relation to participants' share of the total procurement of medicines.
RHF S-Ø RHF V RHF M RHF N LIS-Board S-Ø, V, M, N LIS Working Committee Specialists croups; Cancer, X-ray, MS, TNF LIS-Contact
Working Committee Specialists with medical, pharmaceutical and purchasing-technical background Gustav Lehne chairman, dr.med. specialist in pharmacology and oncology, Oslo University Hospital, Actively contribute with relevant questions and answers about drugs and drug use in the hospitals If necessary specialist groups can be established
LIS Contact persons 1 person from each Health enterprises who: Contributes to the cost-effectivenes use of drugs in the hospital Insures that the hospital drug purchases are in accordance with laws and regulations Implement the chosen substances in the hospital and in the pharmacy Insure loyalty to contract suppliers Insure regular contact with the drug committee and other groups in the hospital concerning pharmaceutical use
Contracts General agreement per Health enterprises: the agreements are binding for both the supplier and the buyer In case of medical reasons other pharmaceuticals than agreed on in the contract can be utilized The general agreements are not of hindrance for clinical testing of pharmaceuticals or research
Drug supply chain Industry/suppliers Parallel importers Alliance NMD Apo Private pharmacies Hospital pharmacies Hospital A Hospital B
Offer Paclitaxel Max AIP Tilbudt AIP Volum Sum Max AIP Sum tilbudt AIP % rabatt % dyrere Accord 5ml 997,38 39,61 2 549 2 542 322 258 163 89,8 16,7ml 3 331,27 101,28 1 877 6 252 794 190 103 97,0 25ml 4 986,92 198,05 1 701 8 482 751 336 883 96,0 50ml 9 973,85 214,69 4 403 43 914 862 945 280 97,8 61 192 728 1 730 428 97,2 51,9 Actavis 5ml 997,38 30,94 2 549 2 542 322 78 866 96,9 16,7ml 3 331,27 70,71 1 877 6 252 794 132 723 97,9 25ml 4 986,92 106,06 1 701 8 482 751 269 387 96,8 50ml 9 973,85 158,37 4 403 43 914 862 697 303 98,4 61 192 728 1 178 279 98,07 3,4 Farmaplus 5ml 997,38 49,44 2 549 2 542 322 126 023 95,0 16,7ml 3 331,27 118,95 1 877 6 252 794 223 269 96,4 25ml 4 986,92 247,20 1 701 8 482 751 420 487 95,0 50ml 9 973,85 338,55 4 403 43 914 862 1 490 636 96,6 61 192 728 2 260 415 96,3 98,4 Fresenius 5ml 997,38 42,60 2 549 2 542 322 108 587 95,7 16,7ml 3 331,27 97,35 1 877 6 252 794 182 726 97,1 25ml 4 986,92 146,03 1 701 8 482 751 248 397 97,1 50ml 9 973,85 218,06 4 403 43 914 862 960 118 97,8 61 192 728 1 499 829 97,5 31,7 Hospira 5ml 997,38 30,15 2 549 2 542 322 182 508 92,8 16,7ml 3 331,27 71,60 1 877 6 252 794 134 393 97,9 25ml 4 986,92 97,21 1 701 8 482 751 165 354 98,1 50ml 9 973,85 149,21 4 403 43 914 862 656 972 98,5 61 192 728 1 139 227 98,14 Teva 5ml 997,38 52,26 2 549 2 542 322 319 721 87,4 16,7ml 3 331,27 125,43 1 877 6 252 794 235 432 96,2 25ml 4 986,92 167,24 1 701 8 482 751 284 475 96,6 50ml 9 973,85 313,57 4 403 43 914 862 1 380 649 96,9 61 192 728 2 220 277 96,4 94,9
Price trends as a result of the annual competition and patent expiration, Paclitaxel 50 ML 13.474 11.351 9.974 Max AIP Generic compitition from 2005 149 LIS-AIP
Price trends as a result of the annual competition and patent expiration, Ondansetron 700,00 600,00 592,24 500,00 400,00 300,00 200,00 100,00 0,00 292,25 397,56 16,72 11,39 Maksimal AIP LIS AIP Patente expiration 2005, generic competition 2007
Price trends as a result of the annual competition and patent expiration, Docetaxel 7.000 6.000 5.000 4.000 5.500 4.855 5.661 5.088 3.000 Maksimal AIP LIS AIP 2.000 1.000 0 888 198 Expected generic competition 2010
The National System for the Introduction of New Health Technologies (methods) within the Specialist Health Service in Norway.
Status Technology Assessment autumn 2015 Under utredning Terapiområde Forventet ferdigs5lt ID2014_023 (Plegridy) MS aug ID2014_039 (Lynparza) OvarialkreJ aug ID2013_030 (Imbruvica KLL) KLL? ID2014_004 (Gazyvaro) KLL aug/sept 2015 ID2014_001 (Imbruvica MCL) Mantelcellelymfom jan 2016 ID2014_021 (Zydelig, KLL) KLL aug/sept 2015 ID2014_022 (Zydelig, lymfom) Lymfom aug/sept 2015 ID2014_037 (Entyvio) Ulcerøs koliz/chrons sykdom aug/sept 2015 ID2015_004 (Cosentyx) Psoriasis sept/okt 2015 ID2015_002 (Otezla) Psoriasis/psoriasisartriZ nov ID2014_036 (Opdivio malignt melanom) Malignt melanom nov ID2014_034 (Keytruda malignt melanom) Malign Melanom nov «Rullerende innlevering» ID2015_006 (Opdivo lungekrej) LungekreJ? «Rullerende innlevering» ID2015_009 (Humira) SveZekjertelbetennelse? "Rullerende innlevering"
Status metodevurderinger 17.08.15 leveringer høsten 2015 Bes5lt, ikke startet enda ID2013_005_006 (Serelaxin)* ID2013_024 (Removab) ID2014_011 (Vintafolide)* ID2014_001 (Imbruvica MCL) ID2015_012 (Cyramza) ID2015_018 (Imlygic) ID2015_013 (Blincyto) ID2014_038 (Cotellic) ID2015_010 (Imbruvica Mb Waldenstøm) ID2014_041 (Keytruda lungekrej) ID2014_042 (Niraparib) ID2015_003 (Vargatef ) ID2015_005 (Kyprolis) Hjertesvikt Ascites ved kreg OvarialkreG Mantelcellelymfom VentrikkelkreJ Malignt Melanom Leukemi Malignt Melanom Mb Waldenstrøm LungekreJ BrystkreJ LungekreJ Myelomatose Forventet start Uavklart MT? Uavklart MT jul.15 aug.15 nov.15 des.15 des.15 Q 4 2015; Q1 2016 sept.15 Avventer dokumentasjon Avklare omfang dok. mars.16
MS Drug cost All prices include pharmacy margin and 25 % VAT Annual cost 2008 Annual cost 2014 % discount Interferon beta-1b (Extavia ) Interferon beta-1b (Betaferon ) Glatirameracetat (Copaxone ) Interferon beta-1a (Avonex ) Interferon beta-1a (Avonex ) Interferon beta-1a (Rebif ) 44 mcg Rebi Smart Kr 164 444 (2010 offer) Kr 114 245 Kr 56 884-50,2 % Kr 114 245 Kr 60 260-47,3 % Kr 113 365 Kr 87 131-23,1 % Kr 113 863 Kr 92 691-18,6 % Kr 122 073 Kr 98 729-19,1 % Kr 115 129-30 % Natalizumab (Tysabri ) Kr 224 653 (Max AUP 2009) Fingolimod (Gilenya ) Kr 253 431 (Max AUP 2011) Kr 187 034-16,7 % Kr 198 745-21,6 %
LIS TNF Specialist Group
Sales anti-tnf in Norway Sales 2006 112 mill. euro Sales 2008 147 mill. euro Sales 2011 190 mill. euro Sales 2014 250 mill. euro
Norway spend the most on anti-tnf? Annually 50 euros per capita in 2014
LIS TNF/BIO tender (Jan 2011 Des 2014) DDD vs. Costs (3-month avg) (index, Feb'11=100; source: IMS) 180 170 160 150 140 130 120 110 100 90 80 FEB11 MAR11 APR11 MAY11 JUN11 JUL11 AUG11 SEP11 OCT11 NOV11 DEC11 JAN12 FEB12 MAR12 APR12 MAY12 JUN12 JUL12 AUG12 SEP12 OCT12 NOV12 DEC12 JAN13 FEB13 MAR13 APR13 MAY13 JUN13 JUL13 AUG13 SEP13 OCT13 NOV13 DEC13 JAN14 FEB14 MAR14 APR14 MAY14 JUN14 JUL14 AUG14 SEP14 OCT14 NOV14 DEC14 DDD Costs Cost per DDD KILDE: IMS
Enbrel turnover vials 2010-2013 special offer inj. subst 25 mg 80000 70000 2013 70 934 6,2 mill. euro discount for 25 mg inj. subst 2011 60000 9,5 mill. euro discount for 25 mg inj. subst 2012 50000 40000 30000 2010 11,1 mill. euro discount for 25 mg inj. subst 2013 2011 2012 2013 20000 10000 2010 0 INJ. SUBST 25MG 4 PRE-FILL SYR 50MG 4 PRE-FILL SYR 25MG 4 INJ PENN 50MG 4
PHARMACEUTICAL PURCHASED WITH LIS AGREEMENTS 2014 Maximum set price mill. euro Price reduc;one mill. euro Pricered. Purchase with LIS agreements 2014 659 186 28,0 % The amounts in million euro including 25% VAT
20 years history and experience with tenders Key success factors Wholesaler agreements Contracts giving delivery safety, financial burden on delivery failure Benefits for pharmacies standardization Specialist Groups with leading medical doctors and patient organization and physicians associations represented in the specialist groups Torfinn Aanes"
Key success factors Seminars with an academic approach, information regarding consumption and recommendations for use Pharmaceutical industry attending the seminars product presentations with competitors present ensures transparency, industry gets to know prices and participates in the discussions Media attending the seminars Professionals and hospitals share experiences Torfinn Aanes"
Key success factors The directors for the 4 RHF s has decided that the specialist TNF and MS group recommendations are an instruction for The Health Trusts This instruction means that the cheapest alternative shall be used in all equal treatments. Deviations from the instruction shall be documented in the patients journal.
Key success factors Started information about biosimilars in 2008 for the hospitals Recommendations presenting price overviews showing annual cost Ensured that economics is part of an assessment for new and replacement patients Torfinn Aanes"
Key success factors Recommendations from the specialist groups provide clinical acceptance Recommendations communicated to all hospitals, seminar participants and on associations websites Spreadsheets for calculating 1. and 3 years' costs Torfinn Aanes"
In September, I m on my first real bike ride in 26 years. Patient revmatologisk dep. Haukeland Hospital LIS agreements allowing us to treat more patients Utne Sørensen, revmatologisk dep. Haukeland Hospital
LIS TNF SEMINAR 28. - 29. JANUAR 2015
Orion winner Hospira loser
Savings 100 % Remsima Martina Hansens Hospital AS Sykehuset i Vestfold HF Sykehuset Telemark HF Lovisenberg Diakonale Sykehus AS Sykehuset Østfold HF Revmatismesykehuset AS Sykehuset Innlandet HF Sørlandet Sykehus HF Akershus Universitetssykehus HF Oslo Universitetssykehus HF Betanien Hospital Skien Diakonhjemmet sykehus AS Vestre Viken HF 1% 8% 9% 9% 10% 12% 14% 18% 19% 20% 22% 25% 64% 2.063.125 7.029.986 5.477.351 5.586.436 19.330.614 3.327.075 11.450.714 14.565.195 24.731.627 16.856.471 6.845.149 3.176.186 4.056.505 0 5.000.000 10.000.000 15.000.000 20.000.000 25.000.000 30.000.000 Kroner
Remsima share of infliximab in volume 100% Helse Nord RHF Helse Vest RHF Helse Midt-Norge RHF Helse Sør-Øst RHF Norge 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1-14 2-14 3-14 4-14 5-14 6-14 7-14 8-14 9-14 10-14 11-14 12-14 1-15 2-15 3-15 4-15 5-15 6-15 7-15
Mørke farger: 2014 Lyse farger: juni 2015 100% 90% 80% Helse Nord RHF 89% 80% Remsima share of infliximab per health trust 83% 100% Helse Vest 93% RHF 87% Helse Midt-Norge RHF 78% Helse Sør-Øst RHF 75% 87% 88% 70% 60% 61% 68% 67% 61% 60% 67% 64% 67% 57% 70% 58% 57% 69% 50% 40% 30% 20% 10% 0% 51% 42% 36% 32% 30% 30% 28% 26% 24% 22% 20% 19% 17% 18% 16% 14% 15% 14% 12% 10% 8% 8% 9% 10% 8% 9% 6% 22% 20% 4% 1% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 1 Finnmarkssykehuset HF 7 Helse Bergen HF 13 Helse Møre og Romsdal HF 19 Sykehuset Innlandet HF 25 Mar;na Hansens Hospital AS 2 Universitetssykehuset Nord- Norge 8 Helse Førde HF 14 Vestre Viken HF 20 Sykehuset ØsVold HF 26 Ikke fordelbare kostnader 3 Nordlandssykehuset HF 9 Haraldsplass Diakonale Sykehus 15 Lovisenberg Diakonale Sykehus AS 21 Sørlandet Sykehus HF 27 Oslo Universitetssykehus HF 4 Helgelandssykehuset HF 10 Haugesund Sanitetsforenings Revma;smesykehus AS 16 Betanien Hospital Skien 22 Sykehuset i VesVold HF 5 Helse Stavanger HF 11 St. Olavs Hospital HF 17 Diakonhjemmet sykehus AS 23 Sykehuset Telemark HF 6 Helse Fonna HF 12 Helse Nord- Trøndelag 18 Akershus Universitetssykehus HF 24 Revma;smesykehuset AS
Biosimilar Inflix market Unit developments 72 % 90 % Remsima price EUR 141.- 38 % Remsima price EUR 184.- 6 % Remsima price EUR 188.- Remsima price EUR 176.-
TNF området DDD utvikling P- 12 Change % YTD YTD- 1 Change % MAT MAT- 1 Change % Row Labels P CIMZIA 68311,19 10,6 % 526147,7 42,3 % 874303,1 72,2 % ENBREL 116338,5-7,4 % 856897,7-6,5 % 1491577-6,2 % HUMIRA 110335,6-10,2 % 820348,1-6,2 % 1450038-2,9 % INFLECTRA - 100,0 % - 100,0 % ORENCIA 4628,47 44,5 % 30622,58 37,4 % 48016,64 29,9 % REMICADE 88373,31-45,8 % 812453,4-34,3 % 1629574-25,5 % REMSIMA 196320,6 395,4 % 1027178 429,8 % 1319926 578,4 % SIMPONI 50902,8 8,2 % 368397,8 0,8 % 623634,7 1,1 % STELARA 22082,48 33,2 % 159744 37,8 % 268573,3 57,4 % Grand Total 657293 13,4 % 4601790 12,4 % 7705643 13,4 % DLI DDD Month Month % change YTD YTD % change MAT MAT % change Stelara 29 667 7,89% 215 326 34,10% 382 402 42,03% Simponi 35 511 11,65% 249 872 16,73% 437 636 21,55% Remsima 197 282 /0 531 926 /0 531 926 /0 Remicade 22 212-88,28% 813 605-25,36% 1 886 387-15,04% Orencia 11 426 38,97% 77 081 80,96% 124 675 85,62% Cimzia 27 429 12,28% 188 684 21,04% 367 569 39,21% Enbrel 65 732-13,82% 448 844-3,96% 854 525-7,81% Humira 98 651-12,22% 734 813-0,32% 1 408 391-1,36% Totalt 487 910 3,76% 3 260 151 13,69% 5 993 511 8,27% Growth % Growth % Growth % vs. MTH DDD vs. YTD DDD vs. MAT Brandname incl. DDD PI 7/2015 7/2014 YTD 7/2015 7/2014 MAT 7/2015 7/2014 HUMIRA (FI) 106 345-6,36 687 062 0,46 1 366 593 5,64 REMICADE (FI) 86 293-33,61 759 227-12,96 1 384 373-2,97 ENBREL (FI) 78 563-3,15 484 905-1,86 951 270 1,71 INFLECTRA HOSPIRA 51 (FI) 707 2 670,00 233 360 1 502,75 250 187 1 514,80 SIMPONI (FI) 41 807 30,21 264 970 38,10 479 127 42,27 CIMZIA (FI) 11 343 8,47 80 114 34,10 144 628 33,70 REMSIMA (FI) 1 627 56,41 10 000 43,68 14 480 9,92 Total 377 684 2,04 2 519 638 8,45 4 590 659 11,17 MTH 201507 MTH 201507 vs. MTH 201407 (%) YTD 201507 vs. YTD 201407 (%) MAT 201507 vs. MAT 201407 (%) Produkt DDD YTD 201507 MAT 201507 Enbrel 189 756 5,42 1 312 614 4,84 2 233 939 5,44 Remicade 282 487-0,32 2 078 435 4,33 3 542 964 5,09 Remsima 16 134-53 655-53 655 - Inflectra 2 827-8 721-8 721 - Humira 230 348 13,93 1 551 326 9,92 2 614 173 9,81 Cimzia 36 998 0,94 249 188 5,49 424 236 11,48 Simponi 77 107 35,16 510 383 40,04 821 282 41,33 Total 835 658 10,06 5 764 323 9,67 9 698 970 9,81
Forside regnearket
INDIKASJON Ulcerøs colitt Anbefalte hjemmebehandlinger Kostnad 1. år normaldose 2015 Simponi (Ferdigfylt sprøyte.) kr 80 334 PASIENTENES VEKT (i kg) 70 Simponi (Ferdigfylt penn.) kr 140 130 Humira (ferdigfylt sprøyte/penn) kr 151 793 TAS INFUSJONSKOSTNADENE MED? Nei DOSEINTERVALL (i antall uker) - Infliximab 8 DOSEINTERVALL (i antall mnd.) - Mabthera 6 Anbefalte sykehusbehandlinger Kostnad 1. år normaldose 2015 Remsima kr 40 462 Inflectra kr 64 157 Remicade kr 129 792
Denmark vs Norway Hospital price DK 2014 LIS hospital price 2014 Diff i % Humira kr. 8 375,50 kr. 5 987,09-40 % Remicade kr. 4 084,48 kr. 3 152,96-30 % Mabthera kr. 9 783,51 kr. 7 856,12-25 % Lucentis kr. 5 775,00 kr. 4 610,10-25 % Gilenya kr. 10 748,00 kr. 9 926,78-8 %
Denmark versus Sweden Hospital price Average offer Diff i % DK 2014 price Sweden 2014 Humira kr. 8 375,50 kr. 8 297,43-1 % Remicade kr. 4 084,48 kr. 3 980,07-3 % Mabthera kr. 9 783,51 kr. 9 545,54-2 % Lucentis kr. 5 775,00 kr. 5 646,25-2 % Gilenya kr.10 748,00 kr.12 500,23 14 %
LIS price reductions annually and accumulated 1,6 Billion per year 1,4 1,2 1 0,8 0,6 0,4 14 12 10 8 6 4 Billion accumulated 0,2 2 0 0 Per år Akkumulert