The Cancer Drugs Fund (CDF) began to crack under increasing pressure last year.

In January, 16 drugs covering 25 indications were dropped from the list even as its budget was increased from £200 million to £280 million and later £340 million. This was followed by a further 16 drugs being cut in September, although seven later got reprieves after negotiations with NHS England.

Unsurprisingly, pharma companies, patient groups, charities and doctors all voiced anger and disappointment over the decisions – most notably, more than 40,000 people signed a petition organised by Breast Cancer Now urging Roche to lower the price of its Kadcyla to keep it on the list.

Even so, criticisms of the Fund itself grew more common from all directions, and a National Audit Office investigation concluded that although it has improved access it is ‘not sustainable’.

As the year drew to a close, NICE and NHS England unveiled long-awaited proposals for a revamped CDF (see p10).

Important step forward for cancer funding

For Novartis Oncology, and for cancer patients, the major challenges in 2015 have been the changes made to the Cancer Drugs Fund, where two rounds of delisting and the closure of the Fund to new medicines made 2015 a year of considerable uncertainty for patients, pharma companies and clinicians.

It has long been clear that changes to our reimbursement system are urgently needed in order to secure a sustainable route for long-term patient access. So the publication of the ‘new CDF’ consultation is an important step forward.

The principles proposed – potential funding from launch, introduction of conditional approval for treatments requiring more evidence of patient benefit, changes to End of Life criteria – allow for the flexibility needed to assess advanced cancer treatments and are vital in preventing bottlenecks that have ultimately led to the ‘collapse’ of the CDF as we knew it.

Will the new system provide the level of access to new medicines that patients have come to expect? That remains to be seen. In its current form the proposal places a high burden on manufacturers – will they be willing to bear the high data collection costs and commercial uncertainty during the conditional approval period? Will the accelerated NICE submissions timelines be achievable? A route for sustainable access needs to work for both the pharmaceutical industry and the NHS.

Barbara McLaughlan, head of external affairs, oncology, Novartis Pharmaceuticals UK

Publish and be damned

Moves to make the relationships between pharma and healthcare professionals more transparent have been a long time in the making. It started in 2012 with a new code on ‘disclosure of transfers of value’ from EFPIA and culminates in June next year when UK pharma companies disclose their payments on a central database.

Yet the debate is unlikely to stop there. Companies are interpreting the rules differently – some allowing HCPs to opt in, others to opt out, for example – and there is already some finger-pointing at companies for seeking ways around the rules. Only time will tell whether these efforts will offer greater transparency or simply an uneven picture of these important relationships.

Most HCPs positive about disclosure

In recent years, there has been a growth in public interest in the industry’s relationships with healthcare professionals (HCPs) and healthcare organisations (HCOs). Members of the public want to be confident that such relationships are appropriate and that they can trust their HCP to provide high-quality care based on clinical evidence and experience.

This is why the pharmaceutical industry in the UK is taking the lead by publicly disclosing details of transfers of value made by industry to HCPs/HCOs in 2015 on a fully searchable central database by 30 June 2016.

In 2015, the ABPI saw the results of many years of planning as the disclosure portal and central database near completion. Industry’s interest in this initiative, as well as other stakeholder groups’ awareness and support, continues to grow, an outcome of regular communication activities and planned engagements.

To better understand the attitudes and behaviours of HCPs in relation to disclosure, the ABPI commissioned a ComRes survey which found that 87 percent agreed that payments from pharmaceutical companies to individually named HCPs should be transparent, while just over two-thirds of those with a relationship with one or more pharmaceutical companies said they had already given or are likely to give permission to disclose their payment information.

With only six months to go until the ABPI’s Disclosure UK central database goes live, these results are very promising.

Karen Borrer, head of reputation, ABPI