Rokshaw: Growing ambitions for specials manufacturer

Rokshaw started as a specials wholesaler in 2012, before expanding into manufacturing in 2014 and stepping into the medical cannabis space in 2018. Managing director Richard Hodgson talks to Saša Janković about what’s next in the pipeline 

Founded by brothers Richard and Jonathan Hodgson in 2012, Sunderland-based Rokshaw is a leading MHRA-approved specials manufacturer and the UK’s first manufacturer of EU-GMP full spectrum cannabis-based medicinal products. 

A family business at heart, the company now has more than 130 employees working across three sites supplying community pharmacies, hospitals, wholesalers and dispensing doctors from its NHS-accredited manufacturing facility – a world away from its two-man beginnings as a wholesaler just a decade ago.

“I was a chartered accountant by profession, but ended up going down the sales manager route. Jonathan was in pharma marketing and product development first for medical devices, and then specials when the company he worked for was acquired by another in that sector,” explains Richard, of the brothers’ journey into starting Rokshaw.

“We’d always wanted to have our own business and since Jon had insight into the logistics side of things and an idea of what didn’t work so well in specials, one day we just decided to go for it. Our older sister Vanessa ran the office, we set up contracts with manufacturers and we bought a database of pharmacies. Jon and I were the sales team and drove around the country meeting independents face to face.”

As the area of the UK with the highest demand for prescriptions of specials, the brothers’ North East location was ideally positioned to capitalise on demand for specials, and they made the most of other advantages that they spotted.

“There are two well-known specials manufacturers in the North East,” says Richard, “but since, when we started, we were wholesalers rather than manufacturers, we based our offering on high quality service with a sensible, cost-effective pricing structure and we built our customer base that way.”

This approach clearly worked as by 2014, they started building their own production facility. “We had great service from the supply chain, but there were always restricting factors from that so we decided we wanted to take ownership of that side of things ourselves,” says Richard. 

“By 2015, we received our MHRA manufacturing licence and our wholesale licence.”

Emerging markets

This expansion of the company and its premises grew the business as the brothers had hoped, and then 2018 brought some regulatory changes that added another dimension to their work.

“Once the UK Government legalised the use of medicinal cannabis in December 2018 by rescheduling it as a Schedule 2 Controlled Drug, we began to see a significant increase in the number of cannabis-based medical products we manufactured,” says Richard.

“This change meant that medical cannabis became an unlicensed medicine overnight, so we had to ensure that we had a supply chain ready in order to cope with demand. Because of this, we joined the EMMAC Life Sciences group – now the European vertically integrated medical cannabis group Curaleaf International – which has given us an opportunity to enter new markets while still improving our specials service to community pharmacies and hospitals across the UK.” 

For context, recent data show the number of unlicensed cannabis items prescribed in England increased more than ninefold year-on-year: the number of privately prescribed unlicensed medical cannabis items dispensed between September and November 2021 topped 14,799 and the number of unlicensed items prescribed to patients in England in 2021 was more than nine times that of 2020.

Medical cannabis

However, Richard admits the change didn’t bring the overnight rush of business from pharmacies that Rokshaw had envisaged.

“We presumed that there would be some inbound enquires from pharmacies asking if we could supply medical cannabis, but that wasn’t the case,” he says. 

“It has to be consultant-led prescribing and access to prescriptions was really restrictive, plus the Department of Health makes it very hard to bring products into the UK in a cost-effective manner. At that time, you had to specifically name a patient to bring the product in for them, which meant we were going to Holland every week to pick product up.” 

Another hurdle, according to Richard, is that there are still no raw ingredients produced in the UK – another reason for joining Curaleaf. “They have their own facility in Spain and can move product into the UK in a more cost-effective manner via their own supply chain, and because we are manufacturers we can convert that into finished product here,” he says. 

On the plus side, Richard says the market is gradually evolving as more consultants become willing to prescribe medical cannabis, and Rokshaw is championing community pharmacies as part of this. “On the whole, the main prescriptions are still going to clinics or online pharmacies partnered with clinics”, he says, “so we want to try to evolve that by bringing in community pharmacies. We know they will see more prescriptions for medical cannabis as more evidence of the benefits progresses.

“The NHS is still not allowing prescriptions on any kind of scale so most people have to get private prescriptions, but we’ve done some educational work with a few hundred pharmacies now and introduced them to clinics that are prescribing cannabis, so at least now pharmacies can help more people know that this exists and help them access clinics.”

Portfolio plans

On the specials side, Richard says Rokshaw can “theoretically” bespoke manufacture any product to order, in a variety of dosage forms. “We provide products covered on Part VIIIB and Part VIIID of the Drug Tariff, as well as unlicensed medicines not covered on these parts as ‘non-tariff specials’,” he says. “Being able to provide an option for any patient is something that we have prided ourselves on as a company over the years.”

And while the number of prescribed specials will always reduce over time – as if they get highly prescribed, they are granted a licence and fall off the specials list – Richard says there will always be room for a specials market for those people who can’t take licensed medicines in their licensed format, such as the elderly, children, and people with allergies.

In medical cannabis, Rokshaw’s predominant dosage forms are dried flower for inhalation, as well as a range of oils. Richard says the company is “working extensively on new dosage forms to further diversify and change the perception of cannabis in the UK market as an accepted medicine”.

This work has important implications. “A lot of the early adopters of using cannabis for medical purposes – apart from children – have used cannabis illicitly,” he says.

“But many people don’t know they can now get this as a medicine and don’t have to buy if off the streets, illegally, and with no consistency of product.

“For example, the higher prescribed format is flower buds, which can be crushed for vaping, and there are now oil prescriptions if people are not comfortable vaping the product, and we can manufacture a dropper medicine format.

“We are also looking at developing capsules which don’t have the distinctive smell, as well as lozenges and liquid vaporisers. We need these other dosage forms that are acceptable for the wider market who don’t want to vape it, to use in a more discreet manner.”

Diverse future

As costs continue to rise across the board, Richard says Rokshaw will keep looking at opportunities for diversifying as the market for specials get squeezed at both ends by licensed products coming on line, and regulators pinching the price.

“The average price for a special was £150 when we started, but now it’s £50,” he says. “That is a significant fall when you think that each product is manufactured individually for each patient, made on one day, quality checked, and sent by courier – and we have to do all that for less than £50 per item if we are going to make any margin.

“Although our introduction to the pharmaceutical industry was as a supplier of unlicensed medicines, we do see our significant growth as a company going towards medical cannabis since it is an emerging market with more healthcare professionals and patients becoming aware of the therapeutic benefits and regulation changes.”

Looking to the future, Richard adds: “There are probably 20,000 patients privately prescribed medical cannabis in the UK at the moment, which is a very small number, but as it works for a lot of people who have tried other things for pain, anxiety and epilepsy, it’s a useful alternative and we are confident that the market is set to keep growing.”