Patient access schemes in the new NHS

Abstract

Patient access schemes (PAS) have become an integral part of the UK pharmaceutical environment. This article investigates the historical role PAS have played in regard to health technology appraisals (HTAs), how the mechanism interacts with other features of the UK funding environment, such as the Cancer Drugs Fund (CDF), and the PAS strategies employed by pharmaceutical companies to optimise funding recommendations. It also takes a forward look towards any role PAS might have in a value-based pricing system, which is potentially facing the UK from 2014. PAS have shifted from outcome-based schemes to financially-based discounts. It is clear that as PAS have become more integral to the UK HTA environment, an acceptance of confidentiality and a requirement to prove that PAS reduce uncertainty to payers are two major developments. The article also highlights how the CDF may act as a potential disincentive for manufacturers to engage with PAS and provide the NHS with discounts to achieve cost-effectiveness. The key going forward is stability; providing a framework which allows payers to determine value, but permits pharmaceutical companies to exist in a credible pricing operating environment.

Market-access agreements for anti-cancer drugs

“…PAS are commercial-in-confidence contracts whose financial results are not made public, so unfortunately there is little official information. 16 We found only two small, not very recent surveys involving hospital pharmacists that tried to assess the NHS administrative burden of PAS in England and Wales. 17,18 Both studies concluded that, in order to prevent missed claims, the NHS did not have the capacity to manage more PAS without funding staff time to manage, co-ordinate and track the contracts.…”

International Price Comparisons of Anticancer Drugs: A Scheme for Improving Patient Accessibility

“…Italy has allocated €80 million to an innovative medicine fund [ 48 ]. Although these funds function by providing immediate access and short-term gains for patients and companies, it is possible that a fund specifically created for anticancer drugs may act as a disincentive for manufacturers to offer discounts to the National Health Service through a patient access scheme in the UK [ 49 ].…”

How can we improve patients’ access to new drugs under uncertainties?: South Korea’s experience with risk sharing arrangements

“…Risk sharing arrangements in the UK, Australia, and Italy National health service (NHS) England has patient access schemes (PAS) to manage the risk of uncertainty and cancer drugs fund (CDF) to provide patients with faster access to new cancer treatments [10,11]. Tracing back to its origin in 2002, there was an agreement between the Department of Health (DoH) and pharmaceutical companies on the long-term cost-effectiveness of multiple sclerosis patients [12]. In 2007, the DoH and the National Institute for Health and Care Excellence (NICE) proposed a legislation of PAS which was applied in the context of value-based pricing under a pharmaceutical price regulation scheme [13].…”