The National Prescribing Centre (NPC) has issued an early warning to NHS organisations about new medicines for which, it says, policy decisions concerning provision should be made ahead of the publication of guidance from the National Institute for Health and Clinical Excellence (NICE).

Specifically, the NPC points to two multiple sclerosis (MS) treatments - Merck KGaA’s cladribine and Novartis’ Gilenia (fingolimod) – noting that patients and clinicians have “expressed an interest” in these products and that both are scheduled for NICE appraisal, although the publication date for each guidance has not yet been announced.

“In the period post-licensing, but before NICE issues guidance, Primary Care Trusts (PCTs) and specialist commissioners should collaborate to make policy decisions about the NHS provision of these treatments,” it says.

The advice comes in the first issue of Tough Choices, a new quarterly newsletter published by the NPC for all NHS personnel who make decisions about the funding and commissioning of medicines at local level.

The Tough Choices feature – entitled New Medicines: Are You Prepared? - also advises NHS personnel to “look out for” two drugs which it says may come to market over the next few months for the treatment of chronic obstructive pulmonary disease (COPD). The first is Nycomed’s Daxas (roflumilast) once daily, which has been proposed for a NICE appraisal but has not yet been allocated a particular wave, and the other is Novartis’ indacaterol, a recently-marketed, once-daily inhaled long-acting beta2-agonist which is not currently selected for NICE appraisal, but for which the NPC has published an On The Horizon review.

Meantime, this month's report from the NPC advising GPs that they could save the NHS money by following NICE guidance on prescribing drugs to treat conditions such as heart disease and diabetes, has been described as “useful but limited” by the National Pharmacy Association (NPA).

The NPC’s advice “is all about what GPs do, not what patients do,” says Nanette Kerr, NPA director of pharmacy, and she calls on the NHS to “look through the other end of the telescope for the big wins. Real value for money can only be achieved if the NHS supports patients to get more benefit from their medicines,” she says.

The NPA is calling for early roll-out of a national medicines concordance scheme in pharmacies across England, pointing out that a structured medicines support service - especially for people newly taking medication for long-term conditions - was promised by the Department of Health two years ago and is now “long overdue.”

“The least cost-effective medicine is one that is used improperly or not used at all once supplied. It is estimated that up to half of all medicines are not taken as the prescriber intended. What is more, adverse drug reactions and poor compliance account for many emergency hospital admissions, which incur a significant financial cost,” says Ms Kerr.