The National Institute for Health and Care Excellence (NICE) sees a role for the Cancer Drugs Fund (CDF), but it needs to be organised differently, Meindert Boysen, NICE’s programme director of technology appraisals, told the Royal Pharmaceutical Society’s annual conference in Birmingham on 14 September 2015.
“It’s a decision by the government to pay for drugs to which we have said no. Do we see a future for something of a fund for cancer drugs, yes, but it has to be on a different footing,” he said during a panel discussion hosted by The Pharmaceutical Journal.
Boysen said the fund had to represent potential value. “It can’t be at all cost. Drugs need at least to prove that they are in scope of what we consider reasonable. Then we do believe that there’s probably a period in which we can explore use of a medicine within the NHS.”
He said some people think NICE simply says yes or no to a drug. “There is a lot more scope for in the middle. NICE is an enabler, NICE supporting the NHS in adopting medicines and tracking their worthwhile [effects] over time.”
Although there have been indications that NICE would have more involvement with a reformed fund from April 2016, Boysen would not comment on how the scheme’s scoring system might change.
“The scoring system is not unreasonable. It’s what doctors think is acceptable,” he said. “We’re not yet really announcing that we are taking it over; that is for the government to decide. We’re happy to support who ever runs that fund in making the right decision. We think it is about managing access rather than rationing.”
David Watson, director of pricing and reimbursement at the Association of the British Pharmaceutical Industry, thinks some companies might have priced themselves out of the scheme, but that “overall, industry hasn’t”. Earlier in September 2015, a spate of cancer drugs were delisted from the fund.
“The industry is frustrated with the existence of the CDF,” he said. “It is slightly unfair on other disease areas that don’t have the equivalent of a CDF because I am not sure it’s the best use of resources overall.
“We’d all hoped there would be further reform to move towards a more stable routine commissioning platform for new drugs. One feature of the CDF that we did see as a potential advantage is the idea of having available funds to kick-start new medicines; not just applied to anticancer drugs, but to other medicines that are really transformative.”
Eric Low, chief executive officer of the patient group Myeloma UK, described the fund as a “policy anomaly” and said his organisation had never been in favour of it.
“The CDF has not been the right solution and we’ve wasted five years messing around,” he said. “What we should have done is sit down with NICE and say what are the issues, why is NICE saying no to cancer drugs. If you ask that question, you can start to get meaningful and sustainable solutions.”
Low believes that with a properly evolved remit, NICE would be perfectly placed to bring drug suppliers and payers together.
Three days after the panel discussion, the National Audit Office (NAO) issued a report stating that the CDF was unsustainable in its current form because of overspending and a lack of evidence on the results it yields. The NAO report comes ahead of a consultation on proposals from NHS England and NICE on reform of the scheme.