Open Prescribing.net How to……... Find Cost Savings Opportunities

Below we describe how to identify cost savings opportunities for your CCG or practice on OpenPrescribing.net. These come under the following categories:

  1. Price-per-unit
  2. low-priority items,
  3. Selecting “cost-saving” from our standard measures
  4. ghost-branded generics
  5.  “Custom” savings

1. Price-per-unit (PPU) Tool

What is the issue?

  • There is wide variation in the unit cost of a number of medicines prescribed across England, due to the way the reimbursement system is structured.
  • We developed an innovative Price Per Unit (PPU) tool that identifies cost savings opportunities by comparing the price paid for each unit (tablet, millilitre, inhaler etc) of each drug across every practice.
  • Every month we estimate what could be saved by each organisation if they were prescribing as well as the best 10%.

How much could be saved?

  • In our paper where we describe how we calculate these savings, we estimated that the theoretical maximum savings from using this tool could be as high as £410 million across England over 12 months.
  • In another paper we demonstrated that within four months of its launch, our tool had already supported cost savings of £243,000 at a practice level and £1.47 million at a CCG level amongst practices using the tool.

How can I identify savings opportunities?

To view a short video demonstrating the instructions below please click here

  • You can access the PPU tool from any CCG or practice dashboard under “Savings on individual presentations”.

  • This gives you a ranked list of savings opportunities based on the latest month’s data:

FIG 1

  • Click on the drug presentation name highlighted in blue in fig 1 (above) to see the available alternative presentations which may allow you to make savings.

  • This gives you a chart looking something like this:

FIG 2 

Circle size indicates quantity prescribed in latest month. 

  • Here you will see the range of brands and/or equivalent formulations (e.g. tab/cap) prescribed by your practice/CCG.
  • In Fig 2 above, you can immediately see some higher-cost presentations at the top (yellow-red circles) which could be avoided if clinically appropriate.

  • Find the full range of alternatives prescribed across the country by choosing the “NHS in England” tab.

  • For more help using this tool, please see our FAQ.

2.NHS Low Priority items

What is the issue?

  • NHS England and NHS Clinical Commissioners have issued CCG commissioning guidance on Items which should not be routinely prescribed in primary care: Guidance for CCGs. 
  • This is a list of prescription items which are deemed low priority for NHS funding and local prescribers should be supported to deprescribe these items in most routine cases.

  • Some of the items are on the list for reasons other than cost-savings, e.g. Dosulepin is included for safety reasons.
  • You may wish to initially prioritise the cost-savings that also have safety implications, dependent on your local prescribing patterns.

How can I identify savings opportunities?

FIG 3

  • Clicking on “View the 18 measures” will show you the CCG’s expenditure on all of these measures.

FIG 4

  • Each measure shows the cost per 1000 registered patients, sorted according to your CCG’s ranking compared to other CCGs (highest first).

  • For each measure you can:
  • see the individual presentations that account for the spend in your CCG;
  • drill down to individual practices to identify those most responsible for prescribing these low-priority treatments:

FIG 5

3. Selecting “cost-saving” from all standard measures

What is the issue?

  • There are some common cost savings opportunities - such as brand-generic switches and high-cost formulations which should normally be avoided - which are included in our “standard” measures.
  • When planning for financial savings you should isolate all the “cost-saving” measures.

How can I identify savings opportunities?

To view a short video demonstrating how to use our measure groupings please click here

1. Click to view all measures...

...then filter the list to only show “cost-saving” measures using our filter:

Or 

2. Select the “Cost Saving” category directly from your dashboard

  • When viewing the list of measures, at the top you’ll find an overview of the estimated cost saving opportunities for your CCG:

  • Measures will be sorted according to your CCG’s ranking compared to other CCGs. You can toggle to sort by the greatest potential savings, highest first.
  • NB this will only show measures which are proportions and exclude those which are calculated as cost per 1000 population.

  • For each measure you can:
  • see the individual presentations that account for the spend in your CCG;
  • drill down to individual practices to identify those most responsible for prescribing high-cost drugs.

  • You can keep on top of any changes in your prescribing by signing up for our monthly email alerts:

4. Ghost-branded generics

What is the issue?

  • Ghost-branded generics are a new relatively new category of cost-saving opportunities, caused by prescribers specifying a manufacturer for a generic product, often resulting in a higher reimbursement price compared to the true generic.
  • Once initiated, patients may continue on these higher-cost prescriptions for their repeat prescriptions.
  • Prescribing this way has been relatively easy to do accidentally in SystmOne practices - see our blog for full details.

How can I identify Potential Savings?

  • Clicking through to the tool will give you a ranked list of products affected by ghost-branded prescribing in the latest month’s data.
  • Those with the greatest possible possible total savings will be shown first:

  • The mean price per unit (PPU) paid by your practice(s) will be shown alongside the price listed in the tariff.
  • You can sort the list different ways using the arrow buttons by the headers, search the list, and download the full results set.

How can these savings be realised?

  • Our data helps you see the scale of the issue for your practice(s) and helps you prioritise drugs to target, but cannot show you which manufacturer was selected for these prescriptions.
  • You can identify the individual patients affected within your clinical system using the new searches and reports created by several organisations, including SystmOne (see here) and PrescQIPP.
  • You can then:
  • Review these prescriptions. Patients could be switched to true generics, if clinically appropriate in each case.
  • Change your “favourites”. Having selected a specific manufacturer’s product at one time in your electronic records system, may have caused them to be automatically identified as favourites, shown in preference to true generics and hence more easily prescribed for other patients.
  • Discuss locally. Most ghost-branded prescribing appears to be accidental because some systems previously allowed them to be selected easily, but they may in some cases be prescribed deliberately.

5. Custom savings

  • As well as all the ways you can identify cost-savings described above, you may wish to investigate expenditure on particular drugs not covered in our dashboards or measures, or monitor the impact of action you have implemented already.
  • For this you can use our Analyse page openprescribing.net/analyse to search for any drug(s) of interest.
  • Please refer to our separate guide for detailed instructions on using this tool.

  • Helpfully, if you would like to return to your analysis later, you can:
  • sign up to a monthly email alert (highlighted in yellow above);
  • obtain a bespoke link (red outline) to share / embed on your website / include in newsletters - it will always give the most up to date version of the chart when clicked on.
  • If you do create bespoke analysis and find it useful, please let us know on [email protected] as we may include it as a measure or on our dashboards!

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