Scotland’s government is investigating its drug pricing watchdog in an effort to stamp out postcode prescribing in the country, whilst also looking to increase best practice.
The review, which has been set up by Scotland’s health secretary Alex Neil, will look at every aspect of how new medicines are introduced - from national advice to local decision-making - to establish whether any further improvements can be made.
The Scottish Medicines Consortium (SMC) appraises all newly licensed medicines and provides advice to NHS boards on their cost-effectiveness, similar to England’s health technology assessor NICE.
Currently, if a medicine is accepted for use by the SMC then individual health boards set the criteria for prescribing; if the medicine is not accepted, then health boards do not make it routinely available.
However, doctors can prescribe medicines that are not accepted for routine use by the Scottish Medicines Consortium (SMC) for individual patients in certain circumstances by special request through Individual Patient Treatment Requests.
Cancer Drugs Fund
There is a similar system in England and Wales, but England was in 2010 given an annual £200 million cash boost to fund new cancer drugs that have not been appraised by NICE, or have been rejected by the watchdog. This extra funding is not, however, available in Scotland, Wales or Northern Ireland, and could perhaps be something considered in the review.
A number of charities have lobbied the Scottish government to allow a Cancer Drugs Fund in the country but Myeloma UK, which represents patients with cancer of the bone marrow, has not been one of them.
The charity's chief executive Eric Low, told the BBC at the beginning of the year that “often the case that there is not enough evidence to justify the very high prices that drug companies charge for these drugs,” adding that in a way, a cancer drugs fund allows drug companies to “get away with [having highly priced medicines]”.
Finding best practice
Professor Philip Routledge, who is independent from the government, will review the medicines assessment processes of the SMC against those of similar organisations elsewhere, such as NICE, to see if there are any areas of good practice that Scotland could learn from.
The chief pharmaceutical officer Professor Bill Scott will also assess how the SMC’s decisions are implemented by NHS boards to ensure there is a consistent and effective approach to prescribing policies across the country. This will include Individual Patient Treatment Requests to establish whether any further improvements can be made.
In a statement, the Scottish government said that the focus of this work was to ensure there is “a consistent and effective approach” to prescribing policies for new medicines across the country.
Health Secretary Alex Neil said: “We know that the Scottish Medicines Consortium is globally respected and has the fastest and most efficient medicine review process anywhere in the UK.
“Some clinicians, charities and patients have, though, raised concerns about access to medicines, so it is only right that we look at ways that we could potentially improve access arrangements. Scotland’s NHS is renowned as being at the forefront of new technologies and innovation – I want to make sure that the same is true of access to new medicines.”
This comes several months after the House of Commons Health Committee announced that it is to hold a short inquiry into the work of NICE.
The Committee said it was examining the way the Institute has discharged its current functions and looking forward to the changes in its role that will come into effect from April next year.