Transforming medicines value: a collaborative, data-driven approach

In response to rising medicine costs and growing healthcare demand, a team in the Northeast and North Cumbria launched a Medicines Value Programme in March 2025. Programme lead Katie Joyce outlines how the ambitious initiative aims to drive efficiencies, improve outcomes and optimise medicine use across secondary care in the region, signalling a move toward a more collaborative, system-wide and data-informed approach.

The NHS now spends over £19bn annually on medicines, up from £13bn in 2010/11, with around half of that spent in secondary care. In the Northeast and North Cumbria (NENC) region, which serves 3.2 million people, secondary care drug costs rose to £668m in 2024/25, increasing at an average rate of 10% annually.

With several high-cost biological medicines due to lose patent exclusivity by 2028, NHS England has identified a £1bn savings opportunity. In response, the Commissioning Framework for Best Value Biological Medicines was introduced in April 2025.

This set clear targets to support the uptake of best value products, including 100% of new patients being initiated on the best-value biologic, where clinically appropriate, within three months of its launch, and at least 80% of existing patients switching to the best value biologic within 10 months of its launch.

The Medicines Value Programme

The concept of ‘medicines value’ was introduced nationally in 2017 through NHS England’s Medicines Value and Access function. This focuses on delivering effective, innovative treatments while securing the best value for public funds.

Building on this foundation, the NENC Integrated Care Board (ICB) has expanded the definition, framing medicines value as the pursuit of quality, efficacy, efficiency and fairness in allocating limited healthcare resources.

Recognising both the challenge of rising costs and the opportunity to improve value, the NENC Provider Collaborative, which is comprised of all 11 NHS Foundation Trusts in the region and works in partnership with the ICB, launched the Medicines Value Programme in March 2025. Its scope goes beyond biosimilars, tackling all high-cost drugs and any practice innovation that improves value, ranging from prescribing pathway redesign to deprescribing and waste reduction.

At the heart of the Programme is the NENC Medicines Value Group – a voluntary, multidisciplinary team that includes pharmacy, medicine and finance professionals. The group operates outside formal integrated care system (ICS) governance but engages closely with established entities like the Formulary Working Group and the Regional Medicines Optimisation Committee.

Key to the Programme’s success is its emphasis on collaboration over competition – an echoed theme from Lord Darzi’s review of the NHS. The Programme emphasises psychological safety and trust, creating space for innovation and open sharing of ideas.

Embedding medicines optimisation principles

The Medicines Value Programme aligns with the NHS medicines optimisation framework, focusing on the four key principles:

Understand the patient experience: changes such as switching from omeprazole liquid to dispersible tablets are supported by patient engagement and communication. Service changes and product design in biosimilar switches are reviewed for patient impact
Evidence-based choice of medicine: prescribing pathway reviews are conducted with clinical experts, supported by tools such as Specialist Pharmacy Service evidence summaries. National Institute for Health and Care Excellence (NICE) guidance and commissioning recommendations inform decision-making
Safe use of medicines: regional audits and dashboard analytics highlight outliers, guide interventions and ensure safe and effective implementation
Integration into routine practice: standardising best practices, reducing duplication and embedding sustainability across all Trusts for long-term improvements.

Digital infrastructure and tools

A cornerstone of the initiative has been the development of a bespoke medicines efficiency tracker designed to generate actionable insights. This tool delivers monthly, transparent system- and Trust-level data. It captures a range of key metrics including overall secondary care drug expenditure, spend on tariff-excluded medicines, costs linked to the ICS high-cost drug block payments, year-on-year variance, and year-end spend and efficiency forecasts.

This tool enables benchmarking, trend analysis and early identification of overspending. It integrates agreed-upon medicine value indicators so that the NENC Medicines Value Group can monitor the impact and progress of the initiatives.

Complementing this, a high-cost drug dashboard uses pseudo-anonymised data to evaluate prescribing patterns, pathway adherence and patient outcomes. For example, evaluating real-world treatment interval data in wet age-related macular degeneration has led to targeted interventions to improve care and cost-effectiveness.

Achieving tangible results in medicines value

By May 2025, the Medicines Value Programme had already delivered measurable progress. It identified £10.47m in forecasted efficiencies for 2025/26 and achieved a 2.7% reduction in April drug spend compared with the previous year’s average, thus reversing a five-year trend of rising costs. Monthly expenditure dropped across six of the region’s eight acute providers, while prescribing practices came under closer scrutiny.

A £700,000 opportunity was uncovered in omeprazole liquid prescribing in secondary care, pointing to a broader £3.4m saving potential in primary care. The Programme also flagged high-cost prescribing outliers, which prompted targeted support and improvement efforts.

A shared medicines cost improvement plan was developed, and a review workshop was held following the ustekinumab biosimilar switch to capture learnings and inform future plans.

For the first time in the region, acute providers shared their medicine cost improvement plans. This level of transparency has fostered creativity, reduced duplication of work and enabled targeted support where it is needed most. A regional gap analysis has identified significant untapped savings and helped to align the resources to deliver them.

The forecasted spend change for 2025/26 is based on the most recent data available, as of May 2025, alongside current intelligence regarding the expected availability of alternative molecules. It assumes a 50% cost reduction for biosimilars, with a linear uptake reaching 80% within 12 months.

For generics, the model assumes a 90% cost reduction and a full switch to generics three months after patent expiry or the anticipated tender award.

Ongoing challenges and key enablers

Key to the Medicines Value Programme’s success has been the voluntary, multidisciplinary participation of stakeholders, underpinned by a culture of trust, psychological safety and shared innovation. Transparent, real-time data tools and emphasis on cross-sector collaboration have further enabled meaningful progress.

However, ongoing challenges remain. Market volatility, including patent expiries and supply chain constraints, continues to pose risks, while limited capacity within provider teams can hinder implementation. Rising costs driven by new NICE technology appraisals also add financial pressure. Perhaps most critically, sustaining engagement across a complex and diverse healthcare landscape remains an ongoing test.

Medicines Value Programme scalability and sustainability

While the NENC model offers a blueprint for transforming medicines value, successful replication depends on local context. Regional variations in governance, commissioning (e.g. Blueteq vs block contracts), procurement and culture must be factored in. The Programme’s strength lies in its adaptability and emphasis on local shared ownership.

Programme participation requires minimal resource investment: typically, one hour per month from members, with additional time contributed by member organisations to deliver agreed initiatives. This modest investment has the potential to generate significant financial and system-wide benefits.

Cost efficiencies achieved through high-cost drug block payments allow providers to reinvest savings into other areas of patient care. Cross-sector alignment further amplifies these savings, and strategic alignment across providers and the sharing of resources enhances system resilience and maximises the collective impact of medicines optimisation efforts.

Conclusion

The NENC Medicines Value Programme is a pioneering effort in regional medicines optimisation. It combines data-driven insights, voluntary collaboration and patient-centred values to drive efficiencies and improve outcomes.

The Programme demonstrates how finite NHS resources can be used more effectively and fairly by targeting unwarranted variations, sharing innovation and embedding medicines optimisation principles. As pressures on the NHS continue to mount, the Programme offers an adaptable and scalable model for delivering greater value through smarter medicines use.