The government’s drug rationing body, Nice, is to be stripped of its power to turn down new medicines for use in the NHS, ending emotive battles with patient groups but raising the spectre of a postcode lottery for care.
The health secretary, Andrew Lansley, believes that Nice, the National Institute for Health and Clinical Excellence, should continue to write guidelines for doctors on the best treatments for their patients, but the Guardian understands he will remove its controversial power to ban the use of drugs it considers too expensive for the benefit they offer.
The move will be greeted with enthusiasm by the pharmaceutical industry, which has opposed Nice from the outset, and by certain patient groups, set up to lobby on specific diseases, sometimes with pharma funding, that have joined cause with them in angry denunciations of Nice when drugs found to have limited benefit have been rejected.
But the decision is likely to cause consternation among the supporters of Nice, who warn of a return to the “postcode lottery” days before Nice came into being, when some patients could get the drugs they wanted on the NHS but others could not.
Critics also point out that careful scrutiny of the cost-effectiveness of drugs is essential to keep drug bills down and ensure that NHS money is not spent on medicines with very limited effect – to the detriment of other patients who may not get the care they need.
“Real growth in the NHS will be about 0.5% in the next few years,” said Alan Maynard, a health economist. “We’re going to have rationing. The question is whether we have it at a national level or let 150 primary care trusts or whatever do it their own way.”
David Cameron’s announcement of a £200m fund for new cancer drugs, made during the election, “drove a coach and horses through Nice”, said Maynard. He said he thought Nice was “under considerable assault”.
Lansley wants the decision on whether a patient should get a drug to be moved back to the patient’s doctor. The local commissioning body will be asked to agree to pay for it. The cost of the drug will be decided through a new “value-based pricing” system. The NHS will negotiate with the manufacturer on a price for each new drug, taking into account not only how clinically effective it is and how it reduces the burden on the patient’s carers but also what other treatments are available and how “innovative” the company has been in producing the drug.
The health secretary told the Guardian that reforming the way medicines were paid for would help ensure money was spent wisely.
“We need a system that encourages the development of breakthrough drugs addressing areas of significant unmet need. And we need a much closer link between the price the NHS pays and the value that a new medicine delivers, sending a powerful signal about the areas that the pharmaceutical industry should target for development,” he said.
“Most importantly, using our cancer drugs fund in the interim, and value-based pricing for the longer-term, we will move to an NHS where patients will be confident that where their clinicians believe a particular drug is the right and most effective one for them, then the NHS will be able to provide it for them.”
The pharmaceutical and biotech industries have heavily lobbied governments for a long time, arguing that Nice is an obstacle to innovation, delaying the introduction of their new drugs into the NHS and sometimes turning them down or restricting the numbers of patients for whom they can be used. Under the new system, they will be able to argue for a premium price for a drug in a new class, for instance, or for one that has required a greater outlay for research and development.
According to the pharmaceutical press, health minister Lord Howe told a conference this week on the future of innovation and drug research and development that Nice was now “somewhat redundant” when it came to deciding the cost-effectiveness of drugs, although its role in producing guidance would remain very important. Howe said the price to be paid would reflect “everyone’s agreed perspective” on its value.
Dr Richard Barker, director general of the Association of the British Pharmaceutical Industry, said he thought it was right that Nice should no longer be able to accept or reject a drug for the NHS. “It should be a clinical decision on what medicine a patient needs, informed by a broader sense of value than the current one that Nice applies,” he said.
He envisaged that Nice would continue to look at the effectiveness of a medicine and give advice, but then the drug manufacturer would meet with the NHS to discuss the price. “We believe a more productive way forward based on some kind of broad assessment of value is for the company to sit down and discuss the outcome of that with the department of health and the NHS, rather than have another body set up. We don’t think there is a disagreement between us [the industry and the government],” he said.
Value-based pricing would replace the current complicated system known as the PPRS (pharmaceutical price regulation scheme), which reimburses companies for the drugs they supply to the NHS. The industry has defended the PPRS in the past, but Barker said he thought it would support the new system – as long as existing barriers were swept away.
At the moment, there are some regional bodies assessing the usefulness of medicines and PCTs have pharmacy advisers and formularies – lists of drugs they are willing to buy – which the industry hopes will all go.
The Guardian Uk