The government's £200 million-a-year Cancer Drugs Fund for England was launched in April 2011 as a short-term solution to drug access issues until the introduction of value-based pricing (VBP) in 2014, but withdrawing it after that date "could prove quite tricky" for Ministers, a leading expert has warned.
At its launch, the Fund was warmly welcomed by many patient groups and sections of the media and, one year on, there is no doubt that many cancer patients have benefitted from gaining access to drugs that otherwise might not have been available to them, according to Eric Low, chief executive of advocacy group Myeloma UK.
The Fund has also meant that many doctors have been able to say "yes" rather than "no" to their patients, while drugmakers have gained short-term benefits from their products getting to patients earlier or in spite of negative appraisals by the National Institute for Health and Clinical Excellence (NICE), Mr Low told a meeting in London this week, held jointly by the BioIndustry Association (BIA) and the Ethical Medicines Industry Group (EMIG).
But, he added, the Fund has also worsened the postcode prescribing lottery in England. Strategic Health Authorities (SHAs) vary in the processes which they use and their interpretations of what the Fund should and should not supply, so the treatments made available to patients nationwide have varied depending on the Authority, said Mr Low. This has led to a doubling of Myeloma UK's advocacy work, he pointed out.
There is also a lack of awareness among many clinicians about how the Fund works, compounded by the role of Individual Funding Requests (IFR) policy and the NHS reforms, plus resentment at the increased bureaucracy and form-filling which it requires or them. And there are real concerns that, with the modest funds which the scheme provides to SHAs, the entire budget could be blown by a single decision to supply just one expensive drug.
Yet another problem is that cancer patients in the UK's devolved regions, and people in England suffering from serious conditions other than cancer, regard the scheme as unfair and unequal. However, at the same time, none of the 10 SHAs spent all the money allocated to them during the scheme's first year, with total underspending across England estimated at close to £62 million.
This suggests that, despite the claims and intensive lobbying by patient groups and others, the problem of access to cancer drugs might not have been as bad as was thought, Mr Low told the meeting.
Myeloma UK's opinion is that the Fund should be viewed as a "temporary and highly-politicised sticking-plaster policy," along with other initiatives such as end-of-life criteria, top-ups, the Scottish Medicines Consortium (SMC)'s use of Quality-Adjusted Life Year (QUALY) modifiers, IFRs, and patient access and risk-sharing schemes. None of these are long-term, sustainable solutions, said Mr Low.
However, he acknowledged that only a few patient groups share Myeloma UK's negative view of the Fund. "It was very controversial right from its inception, and I don't think it's recovered from that," he said.
But, he insisted, the scheme sends a signal to industry that the NHS will pay for or reward mediocrity. It also undermines NICE - which he said "has evolved to become much more reasonable and collaborative in finding solutions" to access issues - and it makes IFR policy even less useful. The Fund has fueled rather than addressed some of the underlying factors and problems of drug access, he said, and called for it to be withdrawn at the end of 2013. "All of us - patients, industry and taxpayers - deserve better," said Mr Low.