Department Of Health
There were 30 responses to this consultation. The majority (87%) of these responses were from pharmaceutical companies or trade bodies.
Following detailed consideration of consultation responses, the department has decided to maintain broad commercial equivalence with the voluntary scheme by implementing the following changes:
- adjusting baseline sales in the statutory scheme by 150 million in 2025, 330 million in 2026, and 380 million in 2027
- introducing a differentiated approach to setting payment percentages for newer medicines and older medicines
- setting the headline payment percentage for newer medicines at 15.5% in 2025, 17.9% in 2026 and 20.1% in 2027
- setting the basic payment percentage for older medicines at 10.6% in 2025, 11% in 2026 and 10.9% in 2027, with a top-up payment percentage for older medicines of between 1% and 25%, if applicable, based on the level of observed price erosion from a reference price
- introducing exemptions to the top-up payment percentage for relevant plasma derived medicinal products and company sales that total less than 1.5 million of a health service medicine in a particular virtual therapeutic moiety (VTM) each year
- increasing the exemption threshold from scheme payments for small companies, from sales below 5 million to sales of less than 6million
Due to delayed implementation and subsequent availability of Q1 2024 sales data (leading to revisions in forecasts for newer medicines and parallel import sales), the payment percentages that the department intends to implement are different to those consulted on. Additionally, these figures extend to 2027 to reflect scheme implementation from Q1 2025 as opposed to Q3 2024.
More information on why these changes were required can be found in Annex G of the accompanying impact assessment.
The policy intent has not changed.