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Drug evaluation and reimbursement in the UK

Learn about the drug evaluation and reimbursement landscape in the UK, including the role of NICE guidance, the Pharmaceutical Price Regulation Scheme (PPRS), and the shift towards value-based pricing to promote innovation and access to new drugs.

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Drug evaluation and reimbursement in the UK

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  1. Drug evaluation and reimbursement in the UK Andrew Dillon Commonwealth Fund - Alliance for Health Reform Briefing on international pharmaceutical policy Washington DC, 7 November 2011

  2. Overview • In theory, any licenced drug can be prescribed through the National Health Service. In practice, drug use is influenced by: • NICE guidance • Local formularies • Fiscal pressure • Budgets for drugs used in the NHS are held by local hospitals for secondary care and by primary care trusts for out-of-hospital prescribing (by General Practitioners)

  3. Pharmaceutical Price Regulation Scheme • Introduced in 1957, the PPRS is a voluntary agreement between the Department of Health and the UK branded drugs industry • Its objectives are to: • Deliver value for money • Encourage innovation • Promote access and uptake • Provide stability and predictability • Member companies sign up to portfolio price control, within which they can price individual products as they wish

  4. PPRS and NICE • NICE appraises most but not all new drugs and new indications • Companies can increase or decrease the price of a drug, after a NICE appraisal of the first indication, if they have a new indication with more patient benefit or if they have evidence of increased benefits for the indication. • Companies can offer ‘patient access schemes’, which effectively reduce the price the NHS pays. These schemes are either: • Financially-based schemes, or • Outcomes-based schemes

  5. NICE: appraisal paradigm

  6. NICE: cost effectiveness analysis 1 x Probability of rejection x Rituximab for follicular lymphoma Imatinib for chronic myeloid leukaemia (blast phase) Trastuzumab for early stage HER-2 positive breast cancer x 0 80 16 32 48 64 Cost per QALY ($’000)

  7. Most new health technologies bring additional value 82% of NICE advice is positive

  8. Value based pricing • Recent UK Government proposals designed to extend the definition of value in UIK drug appraisal and reimbursement decisions • Increased focus on: • Wider societal benefits • Products which address areas of unmet need or high burden of illness • New products with particularly innovative features • Seen as an evolution of and not a replacement for the PPRS and NICE arrangements

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