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An expanded ‘subscription model’ for companies to provide antimicrobials to NHS England will be allocated an annual budget of £100m for contracts awarded during the 2024/2025 procurement process.
Contract tender documents published by NHS England on 12 August 2024 invite expressions of interest for the provision of antimicrobial products via a subscription payment model.
The model, first announced in 2019, incorporates a subscription-type fixed-fee contract value with a performance component, where payment is not linked to the volume of antimicrobials supplied, but rather on the supplier satisfying specified performance requirements, such as surety of supply, stewardship and surveillance.
The tender documents state that individual contract values will be based on one of four value bands, with financial allocation calculated according to how the antibiotics are assessed against a weighted points system.
‘Breakthrough’ antimicrobials will be offered higher contract values, with £20m of funding available per year, followed by ‘Critical’ new antimicrobials, funded with £15m.
The third band covers ‘Priority’ new antimicrobials, which will be funded with £10m, and £5m will available for ‘Important’ new antimicrobials.
Devolved authorities will confirm their respective budgets prior to contracts being offered.
Initial contract terms will be three years, with the option to extend for a maximum of a further 13 years.
The deadline for submissions is 12 September 2024, with final contracts expected to begin in March 2026.
A panel of experts, convened by the National Institute for Health and Care Excellence (NICE), will provide recommendations to NHS England and other UK countries’ commissioning bodies to inform their assessment of bids.
The panel will assign points to each product, the resulting score of which will determine the value band of the contract offered.
The 17 criteria were developed by NICE and NHS England in consultation with clinical experts, grouped into three differently weighted categories: relative effectiveness and unmet clinical need (the most valuable category), pharmacological benefit, and health system benefit.
The first two subscription-style contracts were awarded in July 2022 for cefiderocol (Fetcroja; Shionogi) and ceftazidime + avibactam (Zavicefta; Pfizer).
Following the initial pilot phase, the latest procurement process is intended to widen the pool of suppliers.
The Pharmaceutical Journal reported in May 2024 that the subscription model could be expanded as part of the UK’s second five-year plan to tackle antimicrobial resistance (AMR).
‘Confronting antimicrobial resistance 2024 to 2029’, published by the UK government in May 2024, included proposals to “scale the model to more antimicrobials across the UK”.
Commenting on the tenders, Paul Catchpole, director of value and access policy at the Association of the British Pharmaceutical Industry, said: “The UK’s leading approach offers companies a guaranteed return on investment and contributes, in part, to overcoming the market failure that holds back the development of new antibiotics.
“However, the UK solution is ultimately a local one, and the challenge of AMR is global. We urgently need other countries and regions of the world to offer similar approaches and incentives for antibiotic research and development to ensure we continue to have the medicines we need.”
