Expensive medicines and the nhs

[ConkerBonkers]

I wonder if any of you might be healthier professionals, or similar?

I often read about the nhs refusing to supply up to date, life saving medicines on grounds of cost. Understandably people are getting cross when it's their loved one, but similarly, however brilliant the nhs, it's not in a position to pay the prices the drug companies charge for these high end treatments.

Why can't the nhs give patients the option at least of transferring money to the nhs so the nhs can then buy the drugs, and administer them free of charge. That way people pay a fraction of going private which would be the only other real alternative if they really needed those drugs. My question is, why isn't this am option? Why doesn't the nhs give patients the option of purchasing themselves drugs that the. Nhs can't afford?

Surely anyone in that situation would at least want the option so they could start ago fund me. Or similar, in order to make the payment.

So why isn't this already a thing?

Thank you for reading :)

[titchy]

What life saving drugs are not used by the NHS solely because of cost? I don't think that's actually true...

You can buy drugs on private prescription already.

[ConkerBonkers]

It's been in the news recently that the nhs won't offer some expensive cancer treatments, so that could be an example.

Another one could the preventative hiv drugs which one judge has said the nhs must supply. A decision which many health authorities are disputing because they are massively expensive. Pretend the judge hadn't allowed in favour of the nhs supplying them, if the judge had ruled against it. In that scenario, why wouldn't people have the option to purchase them throughout nhs. Say at cost price plus an administration fee.

[HappyHeart87]

Interesting question, OP. I think I get the concept you're suggesting, but how would we decide which drugs are 'allowed' to be purchased privately? The process of identifying the treatments that the NHS will currently fund / supply is incredibly complex; weighing up the benefits, evidenced efficacy, impact on quality of life etc.

I can't see a way this could happen on a large scale without compromising the NHS's principle of equality of a, really.

[HappyHeart87]

*equality of access

[PitchFork]

What life saving drugs are not used by the NHS solely because of cost
some cancer treaments for example.

dc was refused a script for an nsaids for chronic inflammation. paediatric formulation costs £££ per week in the uk (but tablet form which would have been ok is pennies).

we had to get a private script...

[sallysparrow157]

A lot of the high profile 'too expensive' drugs for example cancer treatments are ones where it's not the cost per se but the cost/benefit - studies have shown that they are not beneficial enough to be worth the cost. Obviously when a person has a disease they as one person may want to take a drug that has a tiny chance of making them better, but the NHS as a whole can't justify treating hundreds or thousands of people with a really expensive drug if there's only a tiny chance that a small proportion of those people will get better. If either NICE or a healthcare trust has decided this is the case, the drug is generally not available privately or otherwise.

On the other hand there are some drugs (or formulations of drugs, like the liquid form rather than the tablet form) which are expensive, GP practices are not allowed to prescribe them as there are alternatives which are deemed just as good, but maybe more difficult to take, or a patient may be allergic to the preservative in it or something, so some people may still need to take the alternative. In this case you can get the alternative as a private prescription and just pay a bit more (ie the actual cost of the drug rather than the often much cheaper prescription price).

[lougle]

It isn't cost per se. It's cost/benefit ratio. So a drug may give increased survival, but it may only increase survival by a mean of 9 weeks and cost £2 million. For the people involved that 9 weeks means everything, but when NICE looks at the C/B ratio they have to factor in the other care scenarios. £222,222 per week is a lot of money.

Other treatments may not yet be proven to be beneficial. So although there may be some anecdotal evidence that a treatment helps, unless a robust trial that weeds out other factors is done, it may not convince the body that it is worth it.

Don't forget though, that the positive decisions don't hit the headlines nearly so well. For example, the trials of the ACE inhibitor Ramipril were so convincing that they were halted early because it was deemed unethical to continue to give placebos to a group of patients when the results were so clearly showing that it was effective.

There are lots of treatments we give that are hugely expensive and yet we do give them without the blink of an eye.

[ConkerBonkers]

Thank you for your great responses, I knew there would be good reasons, just not what! Thank you all :)

[NotAsYoungAsIWas]

I have personal experience of this. My (now adult) daughter has a rare autoimmune disorder and is on a good ol' cocktail of drugs. One of which is an extremely expensive tablet (usually used by transplant patients). There is an infusion drug that has literally JUST been made available without the need for time consuming 'begging' by consultants for extra funding. This infusion COULD mean stopping or at the very least reducing the mega expensive tablets she takes, surely saving money in the long run. I've never seen the logic in it (from a money point of view). Just typed off the hoof - hope it makes sense

[PitchFork]

for clarification: the private script for dc is for the (very cheap) tablet form of the medicine. the tablets are not licensed for use in children but the liquid formulation is (which is 250£ for a calpol sized bottle).
same active ingredient and strength. how silly is that!

[PitchFork]

so rock&hard place situation: paediatric (liquid) is too expensive and tablets are cheap but not licensed so (nhs) gp can't prescribe either

[blaeberry]

Weren't there a couple of wanders private investors in the news recently who were buying up drug companies which made, I presume, generic drugs which no one else bothered to make then suddenly increasing the cost from a few pence per dose to much much more?

The NHS cut-off used to be roughly £30,000 per QALY (quality adjusted life year) gained.

[MargoReadbetter]

PitchFork - you are correct. Paediatric solution will be very expensive and the BNF might state only under specialist supervision. In today's litigious society why would a GP take on the prescribing which was done by a private dr? As it boils down to who signed the prescription if things ever go wrong.

[ChickyDuck]

Yeah it's all about QALYs as PP has said. Basically, one additional year or life in full health is one QALY. A full year of life but where the quality of life is compromised by eg symptoms or side effects of a treatment may be for example half a QALY or a third of one.

The additional life expectancy, adjusted for the quality of life for each year is added up, and the total cost of the treatment is decided by this number to give a 'cost per QALY' for a given treatment. This allows the value for money for a variety of treatments for a given treatment to be compared.

[MargoReadbetter]

Maybe I should clarify - at least for me, cost is not an issue at any time if it's licensed for children and in the BNF. Only if it isn't licensed or says under specialist supervision.

[madamginger]

The problem with liquid drugs is the cost of making them.
Only a few hundred might get a liquid drug compared to a few thousand or more who would get the tablet form, so fewer drug companies would make the more expensive liquid.
For example penicillin tablets cost 92p and the liquid costs £16

[PitchFork]

in our case, there is a liquid formulation available in another european country which costs very little (think calpol vs paracetamol tablets) but nhs chemists are not allowed to import (or so they told me).

can you tell I'm still a bit bitter?

[madamginger]

Some drugs can be imported to the uk via a specials wholesaler.
My pharmacy imports a specialist drug for a child, from the USA but it costs £1100 a month. The GP had to agree to shoulder the cost though.

[TJEckleburg]

private medical insurance doesn't cover drugs. Just allows access to doctors and tests far more quickly. Most private doctors will either write you a private prescription for drugs which are relatively cheap (many generic drugs actually cost less if bought than the NHSprescription charge) or for more expensive ones write a letter to your GP summarising your ur case and recommending that your GP writes a prescription for a particular drug. And most private insurance policies will not cover you for long term chronic conditions - I have one of these and after diagnosis due to v expensive tests paid for by BUPA had to wait for NHS appointment with same consultant to be prescribed drugs which now have to be administered by NHS.