Government looks set to allow top-up fees
pharmafile | September 10, 2008 | News story | Sales and Marketing | Cancer, Karol Sikora, NICE
Patients in the UK could soon gain official clearance to pay ‘top up’ fees in order to receive the cancer drugs which NICE has rejected.
The government’s cancer tzar Mike Richards is conducting a review of so-called top-up fees, which are currently banned on the NHS because they undermine the service’s ‘free at the point of care’ rules.
Professor Richards isn’t due to announce his decision until October, but Pharmafocus can reveal that NICE is already working to produce guidance for ‘non-NHS’ drugs, which could help patients purchase the drugs themselves.
Speaking exclusively to Pharmafocus, NICE’s chief executive Andrew Dillon says it will produce this new evidence base for non NICE-approved medicines for April 2009. It seems this novel form of NICE guidance is a key component for government plans to introduce the controversial top-up fees, and indicates their pending arrival.
‘Top-ups’ have emerged from pressure on ministers to quash the chronic controversy that surrounds NICE when it refuses new drugs, particularly cancer treatments.
Patients can still appeal locally for drugs rejected by NICE, but harsh inequalities arise when some areas grant funding and others seem to invariably deny it due to budget limitations, creating a ‘postcode lottery’ of care.
Currently those denied treatment must settle for an alternative drug, which is often less effective, or else pay privately for the treatment they want and risk having all their other NHS care withdrawn.
This erratic system has rendered ‘top-up fees’ inevitable for a health service failing in both efficiency and consistency, according to Dr Karol Sikora, a renowned oncologist and leading campaigner for NHS reform.
He believes the current situation is unsustainable, and that the Richards report can only conclude that NHS care cannot be withdrawn if patients choose to top-up their treatment by privately purchasing cancer drugs.
Sikora predicts this will precede a revolution in NHS medicines rationing. “It’s not tenable what’s going on. The voter doesn’t like it, and if the voter doesn’t like it the politician doesn’t like it. And if the politician doesn’t like it then it comes to an end.”
Instead, he anticipates a new two-tier system for the health service, in which everyone is entitled to a newly defined free core package of care, which can not be dictated by local trusts. Beyond this, a top-up system should be available to patients for those medicines clearly and universally considered outside of the package.
He added: “What we’ve got to do is define a core package that everyone gets, and make sure everyone really gets it. Not everybody can have everything, but it has to be fair.”
With so many patients vying for treatments rejected by NICE, compounded with a limited national drugs budget, top-ups may seem like a natural progression. But the issue has split the public health community, as the idea of patients paying for treatment contravenes the central NHS value of ‘free at the point of care’.
Dr Karen Bloor, a senior researcher in at the University of York, believes top-up fees will actually reduce the equality of health care rationing.
She told The Health Service Journal that those patients who could afford to pay for additional treatment would benefit over a citizen who has the same condition but more scarce resources. She also warned against a system where individuals and insurers pay healthcare costs as opposed to the strong single purchaser of the NHS. She said there would then be little pressure on pharma to keep drug prices down.
But adding further to the debate, some say introducing ‘top-ups’ will only make official what is already widespread practice. Many cancer patients already top-up with drugs privately under supervision of their oncologist, but it goes unreported at the NHS trust where they receive the rest of their treatment. This is particularly easily done if taking oral medication.
If Parliament accepts the Richards’ October report, NHS ‘top-ups’ could come into immediate affect.
Though ministers are likely to downplay its significance, it will impact thousands of patients currently denied NHS treatment.
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