Ban on ‘top-up’ payments for drugs not working
pharmafile | September 18, 2008 | News story | Sales and Marketing | NHS, par
The King's Fund says the current ban on NHS patients paying privately for 'top-up' drugs is not working.
The Department of Health currently rules that people undergoing a course of NHS care cannot purchase drugs that are unavailable on the health service.
The think tank said this is "untenable" and believes instead that patients should be permitted to pay privately for drugs that have been rejected on cost-effectiveness grounds.
Patients would retain their right to access the rest of their treatment on the NHS under the Fund's proposal.
However, they should also pay for the associated treatment costs over and above the cost of treatment they would have received.
These costs are unknown at present but the Fund called on the government to research what they would be.
The think tank added that the present system is overly dependent on trial data supplied by pharmaceutical companies that "does not necessarily reflect the realities of clinical practice". It does acknowledge, however, that the pharma industry recognises the introduction of new and expensive drugs "must be handled in innovative ways".
It wants what it calls "a more systematic and ongoing appraisal of new drugs in both clinical and economic terms".
"Forcing vulnerable patients to lose out on their NHS-funded treatment because they wish to pay for a drug themselves risks damaging the reputation of the NHS as a caring and compassionate service," the Fund said in a statement.
Inconsistency over patient charging is one of the main issues: top-ups are allowed with NHS optical and dental care, for example, but the use of non-NICE approved drugs is not.
Clarity is also lacking over decisions about drugs which have been approved or rejected by NICE and there are significant local variations between primary care trusts – exactly what NICE was established to avoid, the Fund points out.
There are no agreed figures how many people could take benefit from any changes to these rules, although the King's Fund believes it would be small.
The King's Fund concedes that there are problems with allowing top-ups, including an inevitable division between patients who are able to afford treatment whiles others cannot.
This is why the King's Fund suggested the government specifies circumstances in which top-ups are allowed and calculates the associated costs, such as the costs of administering a drug, and gets patients requiring top-ups to meet them.
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