Cluster page — medicines optimisation
Biosimilars and therapeutic switches
Switch discipline
Switches are clinical interventions, not administrative changes
Therapeutic and biosimilar switching is one of the highest-cost-impact workstreams in PCN-level medicines optimisation, but it is also the workstream that most reliably generates complaints when executed badly. A switch is a clinical intervention: the patient must be informed, consented, supported through any expected adjustment period, monitored where indicated, and given a clear route to raise concerns.
Operationally, switch programmes are pharmacy-technician triaged (cohort identification, eligibility filtering) and clinical-pharmacist delivered (consultation, prescribing, monitoring schedule, switch letter). Outcomes are reported into the PCN savings dashboard and the ICB MO return.
Active switch areas
Where PCN switch programmes most commonly run
- Statin formulary alignment (atorvastatin first-line)
- ACE-i/ARB formulary switches (ramipril, candesartan first-line)
- PPI formulary switches (lansoprazole/omeprazole first-line)
- DOAC formulary switches (where ICB formulary first-line designated)
- Inhaler device switches — environmental impact and cost (NHSE inhaler programme)
- Insulin biosimilar transitions (shared-care with diabetes specialist)
- Adalimumab/rituximab/infliximab biosimilar uptake (specialist-led, primary care support)
Switch KPIs
Programme performance
Frequently asked questions
Biosimilars & switches — FAQs
What is a biosimilar?+
A biological medicine that is highly similar to an already-licensed biological reference product, with no clinically meaningful differences in safety, purity or potency. NHS England drives biosimilar uptake for adalimumab, rituximab, infliximab, etanercept and increasingly insulins, with significant savings at population scale.
What is a therapeutic switch?+
A planned change from one medicine to another in the same therapeutic class (e.g. losartan to candesartan, omeprazole to lansoprazole) where the alternative is equivalently effective and more cost-effective, or where the original has been superseded by formulary update.
Who consents the patient for a switch?+
The prescribing clinician (usually the PCN clinical pharmacist as IP) consents the patient in a switch consultation — explaining the rationale, equivalent efficacy, what to expect, monitoring plan and how to report concerns. Switches are individualised and patient-consented.
How are switches operationally delivered?+
Pharmacy technician runs the eligibility cohort, clinical pharmacist delivers the consultation, switch is prescribed and coded, monitoring (where applicable) is scheduled, and patient receives a switch letter. Outcomes feed the PCN savings dashboard.
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