Cancer Drugs Fund

I said I would report back to our members on the NHS England meeting, held on the 7th September and on any subsequent activity taken by the coalitions of the patient organisations CML Support Group are members of.

The delay in my doing this is because it was widely expected that NHS England would publish details of the consultation on the ‘successor model’ to the Cancer Drugs Fund (CDF) the week following the NHS England meeting, and when that did not occur, the week after that.

The other reason for my delay was that I had hoped to have some news from Pfizer, the manufacturer of bosutinib, about whether they planned to appeal the decision to remove bosutinib from the CDF list (the 20 day window to do so expired at the end of last week) or take advantage of other opportunities on offer to manufacturers in this situation.

Pfizer have responded to my inquiry with what I would describe as a ‘holding position’ saying:

“Pfizer is committed to ensuring that cancer patients can gain access to its medicines, and to this end we will continue to work with the CDF, NHS England and Government to help find a long-term solution to the fundamental challenges that exist in assessing more specialist medicines.”

Assuming the company has not appealed the decision (which is understandable given the very limited grounds for appeal) they have until 4th November to conclude a successful negotiation with NHS England to prevent bosutinib being removed from the national CDF list.

This would almost certainly pivot around a negotiation on price and the level of discount necessary to remain on the list.    

As the Pfizer statement quoted above mentions, the real issue is to develop and implement a new assessment methodology and process for drugs like bosutinib.

These drugs, which in the case of CML are the tyrosine kinase inhibitors (TKIs) -although there are other equally sophisticated classes of drugs for other cancers tend to be for small patient populations with diseases that exhibit a particular target, against which the drug is active.

This makes them expensive on a cost per patient basis, but more discriminating in usage because of their limited suitability.

The Government, NHS and other relevant public bodies, including NICE, accept this is the credible future for pharmaceutical interventions for cancer, but they have consistently failed to develop and agree a methodology and process for their assessment.

In that context, the CDF was supposed to be a stop gap measure (expiring in 2014) until a new long term solution was developed to assess drugs like bosutinib and other second and third generation TKIs.

Over the last five years the abandonment of two proposals - ‘Value Based Pricing’ and its successor ‘Value Based Assessment’- that were supposed to usher in a new era for the evaluation of drugs like bosutinib speaks volumes about the inability and/or unwillingness of Government to act decisively.

The delay in publishing the consultation on a successor mechanism to the CDF indicates perhaps that we are about to witness more of the same.

As for the coalitions CML Support are members of, their handling of this issue could hardly be described as their finest hour.

As a consequence, a group of blood cancer patient organizations are meeting later this month to establish common ground and explore the possibilities for future action. I will report back after this meeting.

David Ryner