Phil Hunt on the missed opportunities of the Health Service Medical Supplies Bill
The £90 million fine imposed by the Competition and Markets Authority on both Pfizer and Flynn Pharma, for charging the NHS excessive prices for an anti-epilepsy drug, is a salutary warning to the pharmaceutical industry. That’s why I welcome the ‘Health Service Medical Supplies (Costs) Bill’, which has its Second Reading in the Lords this week. It will deal with companies who have exploited loopholes by controlling the price of unbranded generic medicines.
At the same time however, the Bill misses a great chance to get rid of many of the restrictions on NHS patients using innovative new medicines.
A recent report by leading charities Breast Cancer Now and Prostate Cancer UK shows that NHS cancer patients are missing out on new treatments being made available in comparable countries of similar wealth. This has been paralleled by a process of delisting drugs from the Cancer Drugs Fund, because it had overspent.
It’s not just in cancer drugs. Evidence from clinical trials has shown that the PrEP drug can be highly effective in reducing the spread of HIV. Yet NHS England has sought to avoid funding responsibility by attempting to palm it off onto cash strapped local authorities. Only following two court cases, did NHS England finally agreed to fund extensive clinical trials.
When Labour set up NICE, we guaranteed that whatever new drugs it recommended the NHS had to make them available within 90 days to all patients who could benefit. But since 2010, access to new drugs approved by NICE have been increasingly impeded. This culminated in the current proposal that if an approved treatment is expected to exceed £20m in any of the first three years of its use on the health service, NHS England can ask NICE to allow a longer period of phased introduction.
It is incredibly disappointing that a ground-breaking agreement with the drug companies in 2014 could have led to many more new drugs being made available. The pharmaceutical industry guaranteed to hold down costs for a five year period with the bill staying flat for two years and then growing only slowly after that. If NHS drug expenditure went over this agreed limit, then the industry agreed to pay a rebate back to the Government every quarter.
Nearly £1.5 billion has already been handed over that could have been used to pay for new drugs, as it has in Scotland. Sadly, the Treasury purloined the rebate by estimating in advance of each financial year how much it was likely to get. That figure was then built into the coming year’s budget for the NHS. This reduced the Treasury’s own contribution to the health service but brought no extra money for local services.
Now, because the health service doesn't effectively get the rebate, NHS England has put huge pressure on Clinical Commissioning Groups to restrict drug costs. The result is that more and more drugs are being rationed whilst the pharmaceutical industry threatens to reduce its investment in the UK, because we are so slow to take up their innovation. This Bill presents a clear opportunity to put patients first by ensuring that the crude and unnecessary rationing of drugs comes to an end.
Lord Philip Hunt of Kings Heath is Shadow Health Minister in the House of Lords. He tweets @LordPhilofBrum
Published 20th December 2016