The NHS England has come under criticism after creating a universal list of oncology medicines that has removed a number of medicines and licences available under the Cancer Drugs Fund.
The single, national list – which will replace the ten previous lists with varying different cancer drugs available – has cut the number of approved medicines and licences for the Cancer Drugs Fund from 129 in August last year to just 64 today.
The Rarer Cancer Foundation, which is partly funded by pharma and has backed the CDF from its inception, said in a statement: “There is no clear explanation about why 65 cancer drug indications have been removed from the list, cutting the list of treatments available by half.”
Treatments/licences which have been removed from the list include:
• Roche’s MabThera (rituximab) for certain blood cancers
• Sanofi/Genzyme’s Campath (alemtuzumab) for the treatment of leukaemia
• Roche’s Tarceva (erlotinib) for the treatment of lung cancer
• Zeltia/Janssen’s Yondelis (trabectedin) for the treatment of ovarian cancer
• Sanofi/Genzyme’s Mozobil (plerixafor) for the treatment of myeloma
Andrew Wilson, chief executive of the RCF, said: “Today’s announcement appears to be a clear step backwards for cancer patients in terms of access to drugs.
“The list of cancer drugs which will be funded has been cut in half with no explanation. We are worried that this will restrict access to drugs which were previously routinely available.
“The UK Government has questions to answer about this, and we will be writing to the Prime Minister to seek urgent clarification about this.”
Ending the postcode lottery
The NHS England said the list’s purpose is to put an end to postcode prescribing of oncology medicines approved under the Cancer Drugs Fund with a new national list of treatments.
Previously, ten local Strategic Health Authorities had control of disseminating the Fund to doctors on behalf of their patients. But these SHAs were spread across the country and had slightly different lists of drugs they were prepared to fund under the CDF.
But from 1 April all ten SHAs were abolished under the radical reform of the health service, and been replaced by the NHS England (formerly the NHS Commissioning Board), which has now taken control of the CDF.
And with this new control the NHS England has created a single, national list of approved medicines doctors can access for their patients, instead of having 10 different depending on where a patient lived in England.
Sean Duffy, national clinical director for cancer at NHS England said: “This is a national levelling up of the number of approved treatments that are available under the Cancer Drugs Fund. This means more people will benefit. It is really important that we stretch every penny of the Cancer Drugs Fund so we get maximum benefit to the most people we possibly can.
“This is a step forward for the Cancer Drugs Fund. In recent weeks cancer specialists from across the country have been working together to agree one national list of approved fast-track drugs for the Cancer Drugs Fund, which will then allow more uniform access to treatment and reduce variation of prescribing across the country.
“Having one consistent method for consideration of overall clinical benefit and funding means that all applications will be assessed by the same criteria.”
Variation ‘not acceptable’
NHS England said the regional variation of the past “is clearly not acceptable for patients,” and added that clinicians can still apply for drugs to join the national list of approved fast-track cancer drugs.
The single national list of approved drugs will contain 28 oncology medicines which will treat around 70 different cancer conditions – but the NHS England did not explain why it has cut the list down by half.
But the body did say that a small number of drugs which were previously on local lists are now available more widely to patients through normal hospital treatment with no special application needing to be made.
NHS England stresses that any patient who is already receiving funding for a cancer drug, or has received confirmation that they will receive funding as part an agreed treatment plan, will continue to receive treatment, despite any changes made to the national list, as long as they and their clinicians consider it clinically appropriate.
NHS England said it will also consider Individual CDF Requests for cancer medicines to treat individuals with rarer types of cancers including those affecting children.
The Fund has come under scrutiny in recent months as both a committee of MPs and cancer charities have questioned what will happened when the Fund ends in April next year.
It injects an extra £650 million into funding new cancer medicines, regardless of cost, for drugs not approved by NICE, or currently under assessment from the pricing watchdog, but there are as yet no plans to extend it past 2014.
A full list of the drugs funded under the Cancer Drugs Fund is here: http://www.england.nhs.uk/wp-content/uploads/2013/03/ncdf-list.pdf