HDA Media And Political Bulletin – 16 November 2016

Lib Dems slam pharmacy cuts and call for cross-party commission

15 November 2016, Pharmacy Business, Neil Trainis


A Liberal Democrat MP, Tom Brake, led a public meeting of constituents where he called for a cross-party commission to ensure the NHS is properly funded. Tom Brake made it clear that although the pharmacy funding cuts are designed to generate efficiency savings within the NHS, the cuts will only add to the burden of the health service during the winter period. Dr Brendan Hudson, Chair of Sutton Clinical Commissioning Group, made it clear that he agrees with the rhetoric of Liberal Democrat Health Spokesperson, Norman Lamb who also believes the NHS needs to be stabilised by a cross- party commission to prevent it being used for political gain.


UK drug funding framework needs an overhaul to ensure the right areas are being prioritised

15 November 2016, The Pharmaceutical Journal, David Webb & Ken Paterson


David Webb, President of the British Pharmaceutical Society and Ken Paterson, Former Chair of the Scottish Medicines Consortium, have expressed their belief that it is time to review the current drug funding framework due to the rising cost of medicines in the pipeline coupled with increasing financial pressure on the NHS. They believe that it is important to include the wider UK public in discussion around the future priorities for the NHS. They warn that with the 20th anniversary of NICE conducting health technology assessments approaching it is time for the UK’s healthcare funding bodies to make a collective and informed decision about which health problems to prioritise based on what the UK population values.


November 2016 Price Concessions/NCSO

15 November 2016, PSNC

The Department of Health have granted the following price concessions for November 2016:

Drug Pack size Price concession
Amitriptyline 50mg tablets 28 £3.25
Bumetanide 1mg tablets 28 £1.95
Candesartan 2mg tablets 7 £2.25
Dapsone 50mg tablets 28 £46.19
Desmopressin 10micrograms/dose nasal spray 60 dose £23.49
Exemestane 25mg tablets 30 £9.60
Flecainide 100mg  tablets 60 £10.93
Flecainide 50mg  tablets 60 £10.70
Fludroxycortide 4mcg/sq cm tape 7.5cm 20 £12.49
Leflunomide 20mg tablets 30 £10.99
Lorazepam 1mg tablets 28 £6.05
Lorazepam 2.5mg tablets 28 £12.50
Metronidazole 400mg tablets 21 £7.88
Naratriptan 2.5mg tablets 6 £24.55
Nitrofurantoin 100mg tablets 28 £14.02
Nitrofurantoin 50mg tablets 28 £16.00
Ropinirole 0.25mg tablets 12 £4.50
Ropinirole 0.5mg tablets 28 £14.85
Ropinirole 1mg tablets 84 £56.71
Ropinirole 2mg tablets 28 £31.51
Trospium Chloride 20mg tablets 60 £15.47
Valsartan 160mg capsules 28 £5.30

No endorsements are required as these prices will automatically be applied to this month’s prescriptions.


When any NCSO or price concession announcements are made, these appear on the Generic Shortages page (psnc.org.uk/ncso) and are emailed to those subscribed to this mailing list.


Parliamentary Coverage

House of Commons Tabled Written Questions, Department of Health, 15 November 2016



Crispin Blunt: To ask the Secretary of State for Health, what discussions he has had on enhancing consultation with and involvement of Pharmaceutical Price Regulation in the preparation and conduct of the forthcoming negotiations on the next such Scheme, in particular industry bodies representing companies directly affected through their participation in the Scheme.




Jonathan Ashworth: To ask the Secretary of State for Health, what assessment he has made of the effect of recent currency exchange rate changes on the import costs of (a) medicines and (b) equipment for the NHS.




Jim Shannon: To ask the Secretary of State for Health, how much the NHS spent on branded drugs after the rebate from the Pharmaceutical Price Regulation Scheme as a proportion of total expenditure in (a) 2010-11 and (b) 2015-16.


Full Coverage

Lib Dems slam pharmacy cuts and call for cross-party commission

15 November 2016, Pharmacy Business, Neil Trainis


The Liberal Democrats added their voice to the growing swell of discontent at the government’s decision to cut community pharmacy’s funding during a public meeting of constituents which produced strong condemnation of the measures.


The meeting was led by Tom Brake, the Lib Dem MP for Carshalton and Wallington, who accused the Conservatives of being “happy to cut off their nose to spite their face” over cuts which are designed to generate efficiency savings in the NHS but which the pharmacy profession feels will only add to the burden faced by a health service under extreme pressure.


Brake also called for the establishment of a cross-party commission to ensure the NHS is properly funded.


Local residents expressed their feelings about the cuts during the meeting which was also attended by Councillor Simon Wales, the deputy leader of Sutton Council, Dr Brendan Hudson, chair of Sutton Clinical Commissioning Group and Renna Barai, an award-winning pharmacist who runs a pharmacy in Sutton.


“These changes are nothing more than a backdoor health cut from the government. We must stand up and let the Conservative government know that these pharmacies provide a vital service in our community and we will not allow them to be heartlessly cut,” Brake said.


“The cuts are due to be made right at the start of winter, at a time when doctors surgeries will already be feeling the strain. The Conservatives are happy to cut off their nose to spite their face and are showing no regard for the kind of joined-up thinking that our NHS needs.


“In fact, the government has not carried out an impact assessment, so the government is ordering funding cuts, without knowing which pharmacies may close, how many patients will be affected or the number of people who will lose their jobs.


“I am in agreement with Liberal Democrat Health Spokesperson Norman Lamb when he says that we need a new deal for the NHS. It is time to stop using our health service as a political football and to establish a cross-party commission to ensure the NHS gets the funding it needs.”


Barai said: “It won’t be big businesses that feel these cuts the hardest – it will be small businesses in our area; businesses that will no longer be able to afford the same level of highly-skilled staff, or that will have to start finding other ways to cope, which can only mean a reduced service for patients.


“Community pharmacies are a local lifeline in the NHS yet the Department of Health has made it clear that they do not see this value.


“These plans will increase pressure on already-overburdened NHS services locally and with GP surgeries, doctors and nurses and A&E departments all overstretched, we surely should not be closing our pharmacies but rather using them more than ever.”


The cuts, due to start on December 1, could force many community pharmacies, including those in Sutton which contains areas of deprivation, to cut back on their services and staff and even close.


UK drug funding framework needs an overhaul to ensure the right areas are being prioritised

15 November 2016, The Pharmaceutical Journal, David Webb & Ken Paterson


If the NHS is to get value for money from medicines, it needs to consider what the UK population values and where its priorities lie.


The National Institute for Health and Care Excellence (NICE) in England, the Scottish Medicines Consortium (SMC) and the All-Wales Medicines Strategy Group (AWMSG) are each charged with making recommendations on which new medicines to fund in their respective countries. Many experienced pharmacists, doctors and other healthcare professionals are involved in and commit time to these processes. All three bodies are highly regarded internationally for the quality and rigour of their work, and all use similar methods to assess the clinical and economic evidence for a medicine in order to reach a conclusion on its value. Yet when these agencies choose not to recommend funding for a medicine, the decision can be met with widespread dissatisfaction from the pharmaceutical industry, healthcare professionals, patient advocacy groups and even politicians. It is obvious that any decision not to fund a new medicine will be unpopular with those directly affected, but the criticism often implies that the fundamental assessment of value is flawed.


This is because the underlying decision-making framework is based on many untested assumptions about what members of society value. It is not the exclusive role of clinical experts to set this framework, it is a collective responsibility as citizens and current or future patients. We need to come together for some difficult conversations.


Value for money


Although often accused of being focused purely on cost-containment and the affordability of new medicines, NICE, the SMC and the AWMSG are, in fact, primarily interested in value-for-money, as opposed to total costs. They weigh up the clinical benefits of new medicines against their costs, assessing their cost effectiveness to make sure that money is spent wisely and efficiently. These decisions are important because annual budgets in the NHS are limited. Any money spent unwisely or inefficiently will lead to other treatments of proven benefit not being provided, known as the opportunity cost of the use of a new medicine. Of course, if the NHS was allocated more money it would be able to make available more options and treatments, but there will always be a budget limit. It will never be possible to fund every treatment and so there will always be a requirement to use funding to the greatest effect.


The opportunity cost becomes more of an issue when the total cost of a new medicine is high. Until recently total cost was rarely an issue for the NHS. However, recent examples of medicines to treat hepatitis C and for pre-exposure prophylaxis of HIV infection have created situations where medicines appear to offer value for money but the NHS cannot always afford to pay for all eligible patients to access them. They are cost-effective interventions that may not be affordable. This throws the question of societal values into sharp relief: we must help the NHS decide how to evaluate and where to incur the opportunity costs. Who do we want to benefit from new medicines, and what health benefits are we willing to sacrifice in order to achieve this?


Singling out certain diseases


NICE, the SMC and the AWMSG work from the principle that UK society wishes to derive benefits from new medicines equally across the population, with no discrimination in favour of, or against, any group of patients. For example, improved health in older patients is valued as much as in younger patients, prevention of illness is as highly valued as its treatment, and no disease areas are regarded as more or less worthy of treatment than others. Although this approach is highly equitable, and completely defensible, it is the very decisions made within this framework that come in for criticism.


The framework itself is rarely formally questioned, but some workarounds have arisen that cast doubt on the underlying principles involved. In 2008, the health secretary John Reid asked NICE to adopt a more generous approach to ‘end-of-life’ medicines, implicitly valuing the health benefits of these medicines more highly than similar benefits from medicines used earlier in the course of a disease [1]. The Cancer Drugs Fund in England makes medicines available that have not met the cost-effectiveness criteria during NICE assessment, potentially displacing treatments that are more cost-effective [2]. As the name suggests, it is restricted to cancer medicines, implying that these are a ‘special case’ and worthy of exceptional funding not available in other diseases, even those, such as heart failure, with similarly poor outcomes. The SMC has a Patient and Clinician Engagement process that is applied to medicines for rare diseases (orphan diseases or equivalent), again making these conditions a ‘special case’ [3]. The possible ‘ethical imperative’ of aiming to provide treatment where there are no other options (sometimes known as the ‘rule of rescue’) may come into play in these situations.


However, the justification for singling out certain diseases or clinical situations is often not based on a clear rationale. These processes have generally come about because of external pressures on the assessment organisations resulting from adverse publicity that has been triggered by individual decisions. There has been tacit acceptance that the changes made match the views of UK society, yet there has been no exploration of whether that is, in fact, the case. The limited evidence that there is[4] suggests that the general public do not favour cancer over other diseases, end-of-life treatments over other interventions[5],[6], or place a higher value on medicines for rare diseases, but the issues have barely been defined or discussed. NICE has undertaken some work in this area with its Citizens’ Council, looking at, for instance, the issues surrounding medicines for orphan diseases, but no clear conclusions emerged to inform real-life decision-making [7].


Review funding framework


Newer and more expensive medicines in the pipeline, coupled with increasing financial pressures within the NHS, mean that it’s the right time to look at the fundamentals of decision-making around funding of new medicines. The clinical specialists who participate in the work of NICE, the SMC and the AWMSG are highly skilled and experienced in assessing the clinical value and cost-effectiveness of medicines, but are not well placed to assess the views of UK society on where and how limited resources should be spent. Their assessment skills and real world insights will remain essential, but the final call will be influenced by the decision-making framework in which they operate, a framework that society needs to develop. If the deliberations of NICE, the SMC and the AWMSG lead to decisions that society believes are wrong, then maligning the bodies themselves, or their individual members, will not lead to different outcomes unless the context for their deliberations is altered.


There is a need to involve the wider UK public in discussions around priorities for the healthcare system, especially in the field of new medicines. Wider and more detailed research into the preferences of society is needed, with a view to incorporating the outcomes of that research into revised processes for the assessment bodies based on objective evidence of societal views. Approaches such as discrete choice experiments [8], where members of the public are asked to express a preference between two or more options and do this for multiple sets of options, allow assessment of the decision-making framework of each individual, and can be combined to gauge the view of wider society.


Other methodologies can be[9], and have been[10], used but none has yet achieved widespread acceptance and all have, to date, had little influence on the decision-making framework of the medicines assessment agencies. The limited experience of NICE’s Citizens’ Council has shown the difficulties that can arise — whether in achieving consensus or even clarity of opinion — but the present situation is far from ideal so new thinking is urgently needed.


Rather than expedient workarounds with no evidence base of their impact or societal preference, we need this detailed assessment of the views of the UK public followed by a rational debate about where NHS medicines expenditure should be focused. These will be difficult discussions involving many stakeholders – current patients, the wider public (who are all ‘future patients’), ethicists, academics in social sciences and health economics, clinicians, those actively involved in medicines assessment and the pharmaceutical industry all have legitimate interests and need to participate. As we look ahead to the 20th anniversary of NICE conducting health technology assessments, we must decide collectively which health problems to prioritise in order to provide an evidence base for future decision-making.

From Factory to Pharmacy

As part of our mission to build awareness, understanding and appreciation of the vital importance of the healthcare distribution sector, we developed an infographic explaining the availability of medicines. It identifies the factors that can impact drug supply, as well as the measures that HDA members undertake day in, day out to help mitigate the risks of patients not receiving their medicines.

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