Thursday, 1 September 2016

PoliticalSpeak: the risk-sharing scheme

What will happen when the risk-sharing scheme comes to an end? #PoliticalSpeak #MSBlog

"Don't you think the letter below is iinteresting? It is from the Department of Health stating that NHS Commissioners' have a mandate to continue to fund the innovator injectable DMTs under the DoH's Risk-Sharing Scheme. What has happened? I suspect that since a bio-equivalent (Extavia) has entered the market some commissioners' want to force MSologists to prescribe the cheaper product to save money. Is this fair? The companies who entered the risk-sharing scheme had to invest a lot of money in setting-up the scheme and have invested heavily in MS services in the UK. They will be short-changed if all of a sudden the Commissioners stop paying for their products."

"What you have to remember is that NICE never green-lighted interferon-beta, nor glatiramer acetate, as being a cost-effective treatment for RRMS. Therefore NHS Commissioners are not mandated to pay of them after the RSS comes to an end. Since IFN-beta and GA became available under the RSS all the other DMTs have been greenlighted. Therefore once the RSS comes to an end in 2017 there is a possibility that the Commissioners (NHS England) may simply stop paying for interferon-beta and GA. This will almost certainly cause problems unless NICE processes a multi-technology appraisal and green-light IFNbeta and GA before then."

"What is interesting is that the price of the innovator drugs have remained the same, except for a slight increase in price of glatiramer acetate (Copaxone), under the RSS rules. You would then expect that with inflation these DMTs would sail through the NICE process as being cost-effective simply because of the effect of background inflation. However, NICE's cost-effectiveness threshold is not inflation-linked and is still fixed at 2001 threshold, i.e. cost per QALY (quality adjusted life year). As a result of this fixed threshold DMTs are getting cheaper every year in the UK and the UK market is becoming less profitable for Pharma. This is why NICE's rules are so loathed by the Pharma industry. On the positive side NICE ensures that the NHS gets drugs cheaper than all other developed nations. Is this a problem? Yes, Pharma like other industries respond to incentives, or disincentives, and since NICE came into being a large number of Pharma companies have closed R&D hubs in the UK and gone elsewhere. Before anyone disagrees with me and points out that GSK has recently announced they will be reinvesting in the UK. I must point out the the sum they will be reinvesting is very small compared to what they used to spend in the UK. In reality they have moved virtually all of their R&D elsewhere (China and the USA)."

"As a lot of high-cost drugs are priced in some countries based on the average, or basket-price, across several countries, which includes the UK, low UK prices reduces prices of drugs in other countries as well. Therefore increasingly as more and more drugs don't get through NICE patients being treated by the NHS will have reduced access to innovator drugs. This is particularly a problem in oncology. It may not make much of a difference when you look at the impact of the loss of access to one drug, but when it affects many drugs I suspect it will start to show in clinical outcomes; NHS patients will have poorer outcomes. In medicine incremental gains, or in this case losses, add-up overtime. The DoH and the NHS have tried to address this by allowing private prescribing under the NHS. In other words if you are wealthy and can afford these high-cost drugs that have not been green-lighted by NICE your doctors can now prescribe them under the NHS and you will be looked after by them in the NHS. In my opinion the latter has proven to be the final nail in the coffin for the NHS as a socialist healthcare system. The NHS was meant to be equitable and free at point of access for all. The private prescribing legislation has created a two-tiered system and is one of the changes that is gradually allowing the NHS to be privatised by stealth."



CoI: multiple

12 comments:

  1. What does Dre think about this?

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    Replies
    1. Or do you mean Snoop Doog?

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    2. I honestly think it was an error for Prof G to have banned Dr. Dre from commenting on this blog, especially when it comes to posts like this one. It is a real disservice to us readers to no longer have his opinions published. A post like this should spark serious debate, yet no-one bothers. It's such a waste.

      Also, Dre, if you're reading, you should not push people in wrong ways, which must have done to have gotten banned! Prof G is tough-skinned, so god knows what you must've said. Be respectful, please.

      Whatever, I miss Dre's presence on this blog.

      Delete
    3. Belinda, if you get this message, then the ban will have been lifted.

      If not, we'll meet in heaven.

      Delete
    4. I had a look in spam there has been nothing posted by Dre since May 31. So since then self-exile just as there was a self-exile before this.

      During the time the blog was closed and shortly afer, it was the wrong time to be picking arguments.

      Smugy pants perhaps an alter ego made a comment in 13 June that was not worth posting as there was no ban.

      However, if posts contain derogatory remarks, they may still be spammed

      Delete
  2. Innovation is needed, only that it has a cost, especially when seeking to innovate in the Medical-Pharmaceutical Industry, and the cost in general is very high.

    New drugs will always be more expensive, for obvious reasons. However as has been stated several times here on the Blog people and even governments themselves, in general have not been able to bear these high costs. Only 1% of the population can afford this luxury peaceful way, are part of a select group. Many countries especially developing decided to break patents on several medications to try to provide treatment to its citizens. But before such a scenario Big Pharma feels less comfortable to invest in new drugs.

    Public health systems along socialist lines haven't been able to afford the cost of such heavy spending. In addition they are pressed by Plans Private Health and by the Big Pharma.

    So what's the way out? To investigate treatments have generic drugs in order to repackage them for other diseases? Don't ever get sick (which is impossible)?

    Hard times....

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  3. The NHS is a political hot chestnut- no one wants to tackle how it is to be funded. When it was set up as 'From Cradle to the Grave", the grave was around 70. Now it's about 85, with a lot of people in that age group having multiple problems- never mind the time bomb of general obesity in the population. A cross party discussion on funding, whether from taxes, private top ups, less services provided by the NHS, free services starting at 70 rather than 60 etc.etc. Blue Sky thinking is needed to save it, and not sitting on Socialist or Capitalist high horses bemoaning the death throes of the NHS.

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  4. Re GSK has recently announced they will be reinvesting in the UK.

    Europe's biggest biomedical laboratory, the Francis Crick Institute, has opened in London. The institute has a partnership with pharmaceutical giant GlaxoSmithKline.
    http://www.bbc.co.uk/news/health-37246994

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    Replies
    1. A common view amongst many f my science friends is that the Francis Crick Institute is an expensive albino pachyderm that drains resources that could be better spent elsewhere.

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  5. It appears as though things are getting preemptive perhaps?

    The costing of meds in the US for various diseases such as MS have skyrocketed and many not so vertical market meds have spiked prices to ride the cash wave. Several entities such as CVS (a large pharmacy) have started dropping meds from distribution via their supply chain.

    Insurers are moving away from Obamacare. People are screaming about the high cost of some of the meds, in MS, everyone is screaming even though they dont pay the say $60,000 a year.

    I've told MS'ers be careful what you ask for you just might get it. Drugs to market is very complex and very very few people understand exactly how complex. These are not handled like chewing gum.

    I suspect costing to insurers will drop as legislators here start screaming post election (is already a presidential campaign issue++). I expect co-pays in the USA will jump to which consumers will scream and yell and completely not understand. "How could the cost go down and my co-pays go up so much!" Because, the "write-off's" afforded their taxable revenues are going to be removed in favor of insurers getting direct cash. Pharma wont loose a dime or make any more than they do now.

    The result of all this will be costs rising globally as the insurers float higher costing globally and make more than they did. The rebate/write off system will be modified and insurers will make more atop it than they do now and in some respects take heat off obamacare.

    While prevalence of MS globally sits in the 100,000 in the UK, 100,000 in Canada, 100,000 in Australia, 20,000 here, 35,000 there, 8,000 over there the USA is more like 450,000-500,000. There lies the issue.

    In other words, 1/5th of all MS sits in the USA, more than UK,Australia, Canada and then some combined. So, the USA is the primary money cow for pharma/insurers that back many (or are involved in financially) of the deemed "National care systems"

    Frankly its happening a whole lot faster than I thought it would happen.

    I expected the "brick wall" to start appearing at least a "TINY BIT" in the distance. That being, longer life expectancy = expense of longer term disability = red ink. Apparently however, insurers are willing jump at the chance of cash in pocket (in the USA) .vs. estimates of writeoffs against taxable revenues?

    Clearly something is looming on the horizon.

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