NICE chief calls on drugmakers for “simple discounts”

Professor Sir Michael Rawlins, chairman of the National Institute for Health and Clinical Excellence (NICE), has suggested that instead of developing complex schemes such as rebates to increase patient access to their innovative but expensive new treatments, drugmakers could simply offer the NHS deeper initial discounts.

NICE “broadly” supports the use of patient access schemes (PAS), because they can increase the cost-effectiveness of treatments and therefore potentially help patients gain access to high-cost drugs, Sir Michael said in an interview with the Financial Times this week. However, he added that such schemes require “substantial management input” and can be complicated for NHS Trusts to implement, and he suggested that a “simple discount” may eliminate the need for such complex schemes.

More and more PAS are being introduced in the UK, but they are not without their critics. The first scheme was agreed between drugmakers and the Department of Health in 2002, after NICE ruled that four disease-modifying drugs (DMDs) – beta interferons and glatiramer acetate – used in the treatment of multiple sclerosis (MS) were not cost-effective. According to researchers writing in the British Medical Journal (BMJ) this June, the scheme had proved a success for the drugmakers, who had sold their drugs to the NHS at close to full price, but for the NHS it had been “a costly failure” and should not be continued

Also earlier this year, a leading patient spokesman told Members of Parliament (MPs) that PAS are not the “most appropriate” way forward, in the long term, to improving access to medicines.

Discussing the landmark risk-sharing PAS for Janssen-Cilag’s multiple myeloma treatment Velcade (bortezomib), Myeloma UK chief executive Eric Low said that drugmakers need to have much more of an incentive to produce better data and to think about price much earlier on the drug development process.

Commenting on Sir Michael’s proposal this week, Janet Knowles, partner and head of the UK biopharma team at law firm Eversheds, emphasises that drugmakers would need to be able to recover some of discounts if their products proved cost-effective for the NHS.

“NICE has pressed for patient access schemes to be based on the cost-effectiveness of a drug but Sir Michael’s comments seem to suggest that the NHS is not yet able to easily determine this,” she says, and suggests that the NHS should perhaps “shift its focus” towards ways of doing this easily and effectively, which would satisfy both the NHS and the pharmaceutical industry.

“The key as ever when it comes to developing measures such as this will be around ‘risk-sharing’ to ensure that both the NHS and pharmaceutical companies benefit,” says Ms Knowles.