Medicine top-ups to be allowed
pharmafile | November 5, 2008 | News story | Sales and Marketing | NICE, par
The ban on NHS patients using top-up payments to receive privately-prescribed medicines has been lifted in a move aimed at easing access to new drugs.
The reform will work in tandem with a less strict NICE appraisal for use in 'end of life’ medicines, which should see more expensive cancer treatments approved by the cost-effectiveness body.
The changes are laid out in a long-awaited report by the government cancer czar Prof Mike Richard entitled ‘Improving access to medicines for NHS patients’.
Announcing the new measures on Tuesday, Alan Johnson said: “The measures I have set out, together with the improvements proposed by NICE, mean that a greater range of more expensive therapies will be available to more patients on the NHS – reducing the need for them to seek private care. "
Johnson said number of patients may still choose to pay for drugs not available on the NHS, but NHS care will not be withdrawn as long as the private treatment takes place in a private facility.
“This issue was causing distress to patients and their relatives – and none of us wanted that uncertainty and inconsistency to continue. Patients and the public can be confident that from today there will be greater clarity, greater fairness and, most importantly, greater access to a wider range of drugs."
Ahead of yesterday's announcement, opponents of top ups said they risked creating a two-tier system which would see the less wealthy receive worse care. The government’s plan do not answer these concerns directly, but will minimise the numbers of patients who will have to resort to top-ups.
But Johnson said he was satisfied that safeguards to prevent this were in place, saying he was “very comfortable as a Labour minister" to be making the announcement.
Top ups
The decision on top-ups comes into effect immediately, and means patients will not have NHS care withdrawn as long drugs which are paid for privately are administered in a private setting.
This means patient will also have to cover the cost of any staff time, tests and scans associated with that treatment. This care can only be given by private providers and away from NHS wards, to avoid patients receiving different quality care.
Prof Mike Richards said he could not estimate how many patients might end up paying for non-NHS drugs, but said the secondary measure – relating to NICE – should mean it would only be small number.
More flexibility from NICE
Raising NICE’s threshold for approving treatments for rare terminal illnesses is a key component of the new plans.
NICE will adapt its QALY cost-effectiveness measure to make it easier for 'end of life' treatments to gain its approval. A less strict QALY threshold will apply to life-prolonging drugs that treat a population of less than 7,000 new patients each year.
Details on the change are yet to be thrashed out, and NICE is to conduct a five week consultation into the matter. It will affect the availability of drugs for rarer cancers where no other treatment is available, such as Sutent, Avastin, and Nexavar for kidney cancer.
Pricing and the Industry
The government is also trying to negotiate with the pharmaceutical industry to bring down drug prices by expanding the use of 'risk-sharing' schemes.
Such schemes see the manufacturer refund the NHS if a patient fails to respond to the drug in question. One notable example of this is Janssen Cilag's current risk-sharing scheme on Velcade, its treatment for myeloma.
Professor Michael Rawlins, the chairman of NICE, backed this approach, and believes it will have an impact on overall pricing of medicines. He said “I have great hopes for the new PPRS and also for these risk-sharing schemes."
He said that the industry had a responsibility to help with the current situation of poor access to medicines, and repeated the view that drugs today cost too much. “Prices should come down," he said
Responding for the industry, the ABPI gave a muted welcome to the plans for top ups.
A spokesman said: “We don’t think [top ups] are necessary at all, the NHS can afford new medicines."
But the body was more pleased about the greater flexibility promised around medicines appraisals. Director-general Dr Richard Barker welcomed it as a step in the right direction for NICE though he said it would be “regrettable if it was the last step it ever made."
He said he would look forward to see more detail on the proposed QALY for 'end of life’ medicines and said he hoped it might one day apply to all medicines.
Barker said: “What patients need now is for further steps to be taken in the overhaul of the NICE decision-making process to make it faster, simpler, more transparent and to reflect the broader value criteria."
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