August 18, 2008

Expensive Medicine Mechanism Must Be Set to Benefit Patients

THE ever-rising drugs bill is one of the biggest headaches for NHS decisionmakers. With some brand-name drugs costing many times as much as a nearidentical formulation under a generic name, doctors have been encouraged to prescribe generics wherever possible. With the annual bill for prescriptions now around GBP1bn, the potential savings are immense. They are not, however, inevitable. Occasionally, brandname drugs can be cheaper, as is now the case with three commonly used medicines which, if prescribed instead of their generic equivalents, would save more than GBP750,000 a year.

Health boards will not be able to benefit from those savings because there is a likelihood of losing out in the long term as the relative prices of brand-name and generic products fluctuate while the board is tied in to a contract. This is a frustrating state of affairs for a health service intent on securing best value for its limited resources, which finds itself at the mercy of the pharmaceutical manufacturers.

The pharmaceutical companies must recoup the cost of research and development, but last year the Office of Fair Trading recommended recasting the Pharmaceutical Price Regulation Scheme so that drugs which provide significant benefits to large numbers of people are more expensive than those that benefit a few to a lesser extent.

This is still under discussion but, as technological advances produce more effective drugs, particularly against cancer cells, there is a danger they are not made available to NHS patients.

Dr Ken Paterson, the chairman of the Scottish Medicines Consortium (SMC), has warned that the soaring drugs bill could bankrupt the NHS. Both the SMC and its English counterpart, the National Institute for Clinical Excellence (Nice), use a formula to calculate whether the extension and improved quality of life offered by new drugs is worth their cost. Decisions that a particular drug does not meet the criteria, particularly when opposite views are taken on each side of the border, are increasingly resulting in criticism and campaigns to make more drugs available to NHS patients. Only last week, Nice was accused of "barbarism" for refusing to approve new kidney drugs. Yet, as the brandnames issue illustrates, how drugs are ordered, supplied and paid for under the community pharmacists' funding agreement is also a factor in the overall cost.

There is no simple prescription for ensuring that the NHS is able to access the best drugs at best value, but it is essential that there is a new mechanism which works in the best interests of the patient and the taxpayer rather than the pharmaceutical companies.

Originally published by Newsquest Media Group.

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