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

Labels: , ,