Pharma Strategy Blog

The challenge for any health care system if how to pay for ever increasing numbers of newer, more expensive drugs while maintaining standards of care. 

In the UK, the Government effectively manages its limited budget by delaying or reducing the number of drugs approved by the National Institute for Health and Clinical Excellence (NICE) and local formulary evaluations by Primary Care Trusts (PCT).  This lead to a postcode lottery where patients in Sunderland could well be treated differently than patients in Salisbury, simply because one PCP allows certain therapies and the other does not.

The USA has a slightly different approach, which nevertheless has the same effect of limiting care, since it offers all the new drugs, but access is effectively limited by who can afford to pay the co-pays and whether they could afford decent health insurance or not.

The UK top up rule change may have a significant impact on cancer care, since previous outcries have occurred with breast cancer drugs such as Herceptin.  If the new ruling comes into place, patients who wish to purchase Herceptin will be able to do so without fear of losing their general rights to NHS care.  It may also potentially lead to faster NICE approvals, which would benefit everyone.

The FT took a more strident view though:

"But in an attempt to limit numbers affected – and to preserve so far
as possible the NHS principle that treatment be given according to
need, not ability to pay – Nice, the National Institute of Clinical
Excellence, is expected to introduce a big increase in the threshold to
assess whether such treatments for relatively rare conditions are
cost-effective.

At
the same time it is expected to issue guidance to patients who may want
to pay, underlining that the treatments in question, which can cost
thousands of pounds a month, typically extend life for a few months for
some patients and do not represent a cure."

The Government is thus ensuring some degree of "consumer protection” to avoid patients being pressed to incur big
debts for treatments with possibly only a limited impact on their life expectancy, as opposed to a cure.