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Public opinion divided over UK drugs spend

Published on 07/10/14 at 04:13pm
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The ABPI would like to see a multi-stakeholder strategic review of stratified medicines and their use in the NHS

A new survey conducted for the ABPI shows that public opinion on whether the UK spends enough money on medicines is split down the middle, with younger people tending to believe it does.

The ComRes poll reveals that just over half (52%) of English adults believe that not enough of the NHS budget is being spent on medicines, meaning 48% believe it does.

The survey of more than 1,700 adults was conducted on behalf of the ABPI in August, and shows that this percentage rises slightly in older adults, with three in five (60%) adults aged 55 and above believing that the NHS’s spend on medicines was ‘not enough’.

But this is compared with two in five (40%) of adults aged 18 to 24, meaning 60% did believe enough was being spent.

Opinion was also divided across the sexes, with three in five women (57%) compared to half (47%) of men polled believing that not enough is currently spent on medicines, compared with other NHS spending on hospitals, staff and equipment.

The total NHS drugs bill spend was £13 billion last year, with £12 billion of this being disbursed on patented medicines.

The survey also shows:

• Nine out of ten (90%) English adults believe that the government should do more to make sure that people across the UK can get the latest medicines when they have a serious or life threatening illness.

• 93% of adults polled agree that patients in England should have a right to the same medicines that are available to people living in Scotland and Wales and vice versa.

• More than three in five (63%) of English adults believe that if the NHS budget increases, some of the extra money should be spent on providing the latest medicines than in other areas.

• A third (32%) of English adults say that a political promise to spend more on ensuring that people with serious or life-threatening illnesses could have the latest medicines would make them more likely to vote for the party in question.

Prices and access

Pricing of drugs and market access issues are two major political hot potatoes, and the government has issued a number of policies aimed at appeasing pharma’s concerns whilst also helping patients (see below for more).

But the issue around NHS spending on drugs has turned a corner this year, with NICE becoming far more vocal over rejecting new medicines for health service funding because of their high costs.

This came to a head in August when NICE rejected Roche’s new breast cancer drug Kadcyla (trastuzumab emtansine) because of its eye-watering £90,000 price tag.

NICE said it was ‘disappointed’ with the Swiss firm’s costing, adding that it would need a 60% price cut to be cost-effective, which Roche rejected out of hand, saying it was in fact NICE that needed to be changed to allow more expensive medicines through.

Typically the mass media sides with pharma, as NICE’s chairman Professor David Haslam explained to Pharmafile earlier this year, but on this occasion public opinion seemed to swing toward NICE given the sums at stake.

In fact a public petition to force Roche to lower the cost of Kadcyla was posted online by a cancer survivor last month, who said the firm should be ashamed of its price tag and must make it more affordable to the NHS. It has since received more than 8,000 signatures and many negative comments aimed at makers Roche.

Just one example, but it demonstrates a shift in thinking over drug pricing, which is also changing around the world with nearly all payers – including the usually laissez-faire US market – now questioning whether medicine prices should be so high, especially in such a tough economic environment.

Political drives

The ABPI represents nearly all of the major UK pharma firms, and Pharmafile has been told the bigger companies can pay around three-quarters of a million pounds for membership.

This survey comes against the backdrop of the party conference season in which all the major parties have promised to make the NHS a priority over the next Parliament, despite continued constraints on public spending.

The Labour Party and the Liberal Democrats have offered NHS funding increases of more than £1 billion, while the Conservatives have said that they will protect the NHS budget in real terms until the next decade.

All parties have been told that this will not be enough by health think-tanks such as the King’s Fund however, which contend that the NHS needs an £30 billion by the end of the decade just to keep up with demand.

This may mean that with all the will in the world, the NHS may simply not be able to pay for new treatments from the industry.

The government has created several silo funds for new medicines over this Parliament, including a £200 million a year Cancer Drugs Fund (CDF), which pays for new oncology treatments not recommended by NICE, and an £18.7 million fund for Gilead’s new hep C treatment Sovaldi.

The CDF has in fact just seen its annual allowance upped to £280 million a year – but things are not all as they seem. The need for the increase comes from a growing demand and rapid rise in cancer drug prices, which NHS England, who runs the Fund, is struggling to keep up with.

In fact, NHS England is now consulting on new plans to cut some drugs from the Fund and cost-assess others to keep spend down.

Its siloed Sovaldi fund is also coming under pressure, and just this week new internal NHS documents seen by the Health Service Journal show that if NICE recommends the drug, which it is currently minded to do, its £35,000 price tag will see the NHS spend £1 billion on the treatment next year alone.

The documents says that this is simply too high and may have to bar or limit its use/cost across the health service.

Pharma manifesto

But despite all this, the 2015 general election is still looming and the ABPI is keen to get its message about drug prices out into the political spheres. The ABPI also notes that access to treatments is a big issue for many British voters.

To this end, the ABPI has released today its ‘manifesto’ which is calling on the next Parliament to “redouble efforts to boost patients’ access to innovative medicines”.

It also wants a political reform of NICE, and for the next government to decide whether its QALY formula should continue to be used as the main source for assessing the cost-effectiveness of medicines.

The ABPI’s new president Jonathan Emms has already told Pharmafile he doesn’t think it should. It also wants to “embed accountability for delivering patients’ rights to access new medicines, on the advice of their doctor, in NHS England’s performance monitoring system”.

Finally, the ABPI would also like to see a multi-stakeholder strategic review of stratified medicines and their use in the NHS – to identify key challenges and recommend further policy measures that would improve patients’ access to these innovative medicines.

Good and bad times during current Parliament

UK pharma PLC’s time under the current coalition government, which began in May 2010, has been a mixed bag. On the positive side the coalition, led by the majority Conservative party, have decreased taxes for the industry in the form of the patent box and established the ‘Innovation, health and wealth’ (IHW) report, which aims to encourage innovation in the life sciences as well as the NHS, whilst potentially also speeding up approval times for new drugs.

The prime minister David Cameron has in addition, taken a large interest in health issues, establishing new funds for Alzheimer’s research and investing more than £1 billion over a five-year period into the Cancer Drugs Fund.

Former universities and science minister David Willetts MP also became heavily involved in championing pharma before stepping down earlier this year, even coming out in 2013 to fight in AstraZeneca’s corner over the low uptake of its new but poor-selling blood thinner Brilinta.  

But on the flip-side the government has this year introduced a new PPRS drug pricing deal that sees the UK industry have to pay a rebate to the Department of Health each quarter, should it sales grow more than the agreed amount, which has so far amounted to £150 million refund for the first six months of 2014.

The government had also promised a major reform of NICE in order to ensure more drugs would pass through its appraisal system, but this has been delayed and watered down, much to the frustration of the ABPI.

Ben Adams 

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