Integrated care boards (ICBs) are considering whether to recommend primary care networks (PCNs) switch patients with atrial fibrillation from edoxaban onto apixaban.

NHS England advised commissioners last month (16 January) to consider developing a local policy to review direct oral anticoagulant (DOAC) prescriptions among patients.

In its commissioning guidance, it stated that clinicians should use the ‘best value DOAC’ that is clinically appropriate for the patient, with generic apixaban ranked at number one and edoxaban (Lixiana) ranked at number two.

It comes after the loss of exclusivity of apixaban, with stock of generic product now available to the NHS.

West Yorkshire ICB and Leicester, Leicestershire and Rutland ICB both confirmed they are considering the guidance, with the latter stating it is ‘currently looking at the feasibility of changing prescriptions of patients already on a DOAC to apixaban’.

Similarly, Derby and Derbyshire ICB said it is ‘considering developing a local policy to review patients’ current and appropriate treatment’.

Our sister title Pulse PCN contacted all ICBs and a number confirmed, however, that they do not plan to require patients to be switched after consideration.

Dorset ICB stated that it will not be pushing for switching patients onto apixaban following a consultation with its primary and secondary providers.

And neither does North West London ICB have any plans for switching patients on edoxaban to apixaban.

Greater Manchester ICB said it was 'currently undertaking a review of the NHSE commissioning recommendation'.

'NHS GM’s preferred first line agent in non-valvular atrial fibrillation is apixaban,' the ICB added.

In November, NHS England confirmed it would review its commissioning recommendations for cardiovascular disease (CVD) after a cheaper DOAC – apixaban – appeared on the market.

At the time, Pulse PCN confirmed that edoxaban stood at £49 per patient per month, with apixaban priced at £15.73 – £16.19 per patient per month.

NHS England had incentivised PCNs to start prescribing edoxaban to new patients and consider switching patients over, under the 2022/23 Network DES, following a procurement deal with the manufacturers.

The wholesale switch to edoxaban was encouraged under the Investment and Impact Fund (IIF) indicator CVD-06 in March 2022, with PCN directors concerned that the workload involved would be too great.

This article first appeared on our sister title Pulse PCN.