My letter from the Earl Howe (via my MP) said:
"I would stress that NICE has not yet published its final guidance to the NHS. It currently expects to do so in September 2011. I am sure that you will understand that I do not wish to pre-empt NICE's final guidance in any way. Should NICE be unable to recommend these drugs for imatinib-resistant chronic myeloid leukaemia, it will be for local primary care trusts to decide whether to fund these treatments based on the patient's individual situation and, as I explained in my previous letter, the Cancer Drugs Fund is now operating to enable cancer patients to access drugs that their doctors want to prescribe."
Nothing new there, then.
He goes on to say:
"In the longer term, we want to change the way drugs are priced so the price to the NHS is based on an assessment of its value, rather than pharmaceutical companies being free to set whatever price they choose. Currently, the NHS is faced with the decision of whether to say, in effect, "yes" or "no" to a new drug at the price proposed by a pharmaceutical company. The NHS is in some respects a "price taker" in this current system, and its only real option if the price of a drug is set too high is to restrict its use. Our proposals for a value-based pricing system will ensure licensed and effective drugs are available to NHS clinicians and patients at a price to the NHS that reflects the value they bring."
The implication of this that he expects some to decrease and none to increase. However, the logic of this position is that some very cheap drugs such as aspirin and statins, which are extremely valuable to the NHS in disease prevention, would increase substantially in price. In practice, with cheap generic drugs, that won’t happen, so it becomes simply an arm-twisting exercise for expensive drugs, which is the present situation.
He ignores the cost of development, materials, processing and low production volumes. If the price is set too low, the pharmaceutical companies will decline to supply and his last sentence would be rendered meaningless. In fact, if NICE declines to recommend the drug on cost grounds, that is the current position - I haven’t noticed drugs companies rushing to reduce their prices in the face of a NICE rejection. After all, the UK is not a large part of the global drugs market.
To sum up, it is a futile exercise and will change nothing.
John
