The government's drug pricing policy is still full of holes

Health policy news has rightly been dominated by goings on at the Care Quality Commission but, buried under the furore over cover ups, redactions and whodunits, the Department of Health has tried to make progress on another political hot potato − access to drugs.

‘Drugs pricing policy is hardly more straightforward than it is scintillating. It makes the tariff look like a model of populist simplicity’

Love it or loathe it (or simply accept it as a necessary part of life), the Cancer Drugs Fund has largely defused access to drugs as a mainstream issue (think how often the Daily Mail has front page splashes on drugs now compared to 2009-10). This policy is, however, time limited (and of course only applies to cancer). 

Next year is due to herald the introduction of an overarching system that is meant to solve the underlying problems in access to medicines, place greater power in the hands of doctors, deliver better value to the NHS and reassure patients that they will get access to the drugs they need, irrespective of where they live or who treats them. 

Clear intent

This is some ambition, but it depends on overhauling the way medicines are priced. Drugs pricing policy is hardly more straightforward than it is scintillating. It makes the tariff look like a model of populist simplicity. Perhaps it was this combination of fiendish complexity and communications difficulty that attracted Andrew Lansley − its great advocate − to the issue in the first place.

Yet, as with many issues championed by Mr Lansley, beneath the complexity was a clear diagnosis: “NHS patients rightly expect to be among the first in the world to access effective treatments, but under Labour they are among the last.” 

‘It remains unclear whether the DH will come anywhere close to realising the grand ambitions which were set for the policy’

There was also a clear statement of intent about what he wanted to do: “We want more people to access the drugs and treatments that would prolong or improve their lives by reforming the way drug companies are paid for NHS medicine.

Whether the diagnosis and prescription were correct is of course a matter for debate. But the clarity of the analysis or sense or purpose is unmistakable. And this was supported by more than just Andrew Lansley. The commitment to value based pricing in the coalition agreement is far clearer than many other aspects of health service reform, which were pushed through at far greater pace.

Ambtion without action

The scale of ambition in the policy has not been matched by action to develop or implement it. Three years on from the formation of the coalition and only six months before the policy is due to come into effect, it remains unclear whether the DH will come anywhere close to realising the grand ambitions which were set for the policy.

‘It is hard to escape the feeling that this is still a policy where the delivery is riddled with holes’

Protestations of progress are only serving to reaffirm rather than rebut this impression. In March the government trumpeted that the National Institute for Health and Care Exellence would take responsibility for assessing the value of medicines − something it had already confirmed nearly two years earlier. Hardly breaking news. 

The publication this week of a blueprint for how NICE should conduct value assessments (and consider the wider value delivered to society) and the consultation on a new statutory pricing scheme (to run alongside the next pharmaceutical price regulation scheme) hardly change this. The former provides scant detail about how such assessments will actually be conducted and the latter, which has to be published by law, offers a wide range of cuts with no explanation as to their basis − surely the whole point of the exercise.

It is hard to escape the feeling that this is still a policy where the delivery is riddled with holes in all the important places. Nearly everyone agrees with the concept of a value assessment; the issue is how that assessment is undertaken. Equally a consultation about a price cut that offers no clue as to what that cut may be is little more than pointless.

The Cancer Drugs Fund may have been about buying the government time to fix the underlying problems in access to drugs, but the clock is ticking. This is a policy that urgently needs flesh on the bones. The morsels offered up by the Department of Health so far do little to change this.

Mike Birtwistle is managing director at MHP Health Mandate