Global Report: Not So NICE

What can the pharmaceutical industry do to improve patient welfare? This is what "The Right Medicine, the Right Patient, the Right Time," a manifesto recently published by the Association of the British Pharmaceutical Industry, attempts to answer. The report was written largely in response to drug-access gaps created by a disconnect between the United Kingdom's National Institute for Clinical Excellence (NICE) and the country's Primary Care Trusts (PCTs), which make reimbursement decisions on a local level.

Sarah Houlton

The report provides ideas on how the pharmaceutical industry can support—and improve—the National Health Service, according to ABPI president, and managing director of Sanofi-Aventis UK, Nigel Brooksby.

"The NHS was built on fairness, but it's not fair when some patients are not getting medicines that could make them better or even save their lives," he said. "It's not just a moral issue—if we get it right, we can also save money for the NHS."

While preparing to take over as ABPI president earlier this year, Brooksby asked more than 150 stakeholders how they perceive the pharma industry, and how getting the right medicines to the right patients, at the right time, could be facilitated. These stakeholders included company executives, doctors' organizations, research councils, and patient groups, as well as the association's own experts.

Brooksby identified a number of common theories on what industry could do to improve patient welfare: Put patients first, be open to working together with different stakeholders, be transparent and open, and focus on innovation.

One of the biggest areas of concern addressed in the ABPI report is drug availability. NICE was created to prevent "postcode prescribing," a term used to describe a UK dilemma by which drugs are made available to residents of some zip codes and not others. Because a PCT makes ultimate decisions on reimbursement locally, priorities differ from one part of the country to another. The result is that some patients have access to certain expensive medicines, while others equally in need do not.

Industry has been concerned for years about poor uptake of new medicines in the United Kingdom—and NICE has not helped the situation. Rather than providing guidance that requires PCTs to pay for certain treatments, NICE tends to point to its guidances as a reason for delaying payment for expensive new medicines while it deliberates their effectiveness. This introduces further delay into the system.

And even when NICE has said that drugs should be available to all in need, patients still often do not get them, because they need to clear it with their PCTs. PCTs often cite a lack of money, leaving patients with no choice but to go to court to try and force the PCTs to pay.

Brooksby says that in addition to the postcode lottery, there's also "passport prescribing."

"Other countries are getting the medicines that are discovered here, and we are not," he said. "The UK has a lot to be proud of with our global innovations and global sciences. But other countries show the way forward with prescribing."

Notable examples include cancer medicines, less than half of which are available to UK patients within five years of their launch. Drugs to treat dementia and diabetes also are tough to get.

Yet ABPI claims that just 11 percent of the UK health budget is spent on medicines, and last year's drug bill actually fell by 3.8 percent. Although drug spending in the United Kingdom is expected to grow by 5.5 percent in 2006, that is still lower than past growth rates, which averaged at about nine percent.

"The most important contribution to drugs' share of the bill is actually volume, not price," said Richard Barker, ABPI's director general.

"We are working very hard on these problems with central governments, and we are also trying to do it at the PCT level too now," added Barker. "While the industry frequently talks to prescribers, I don't think we have put enough time into talking to management within the PCTs. We are now starting to sit down with PCT management to talk about common problems."

"In my mind, the pharma industry exists to make people better," Brooksby said. "Paying for medicines can prevent hospitalization by treating patients at home. It's better for patients, their families, and the NHS. For example, the annual cost of not treating obesity in the United Kingdom is estimated at £7 billion. Yet modern medicines are not always getting to patients as quickly as they should, and not even when NICE says they should. Has NICE ended postcode prescribing? No. Will it in the future with help from us and other stakeholders? I believe it will."

Sarah Houlton is Pharmaceutical Executive's global correspondent. She can be reached at sarah@owlmedia.co.uk