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Value-based pricing could lead to postcode lotteries, NICE warns

By Lilian Anekwe

NICE has called on the Government to scale back its plans to overhaul the drug pricing and evaluation system in order to avoid a postcode lottery in access to new drugs.

In its response to the consultation on value-based pricing, NICE said ‘the objectives are laudable but the value based pricing system proposed is not enough to ensure that the objective of better access to new drugs will be achieved.’

The Department of Health consultation on proposals to move to a system where drugs are approved for use in the NHS on the basis of their ‘societal value’ closed last week.

Under value-based pricing system from 2014 NICE guidance would become only advisory, the £30,000 per quality-adjusted life year threshold the institute currently adopts for approving drugs will be scrapped and GP commissioning consortia would be given the final say as to which drugs are offered to patients.

But NICE warned that the Government’s ‘presumption’ that all drugs would be offered by all consortia may not transpire under GP commissioning, where ‘local judgements will prevail’.

Instead, NICE called for access to drugs to be inscribed as a right in the NHS Constitution to avoid postcode lotteries.

Although NICE chief executive Mike Dillon said the institute supported the ‘general principles’ behind the move, the response called on ministers to ‘modify the ambition for value-based pricing’, after identifying several key concerns.

It also called for the new system to be piloted and evaluated before any changes were implemented.

The response stated: ‘We are very concerned that the way in which it is proposed to vary the threshold for assessing the cost effectiveness of new drugs… will lead to poorer value for money and less efficient use of NHS resources compared to the current arrangements.

‘Although it seems that NICE will not be asked to produce guidance in the form it currently appears, it is not clear in what form any advice from NICE might appear.

‘The presumption that if a new drug is deemed to have an acceptable price it will automatically be available when a prescriber and their patient wish to use is by no means certain in a new NHS system, where it seems that local judgements about affordability and priorities will prevail.

‘The right of access to treatments that have been accepted as being fairly priced should be secured under the NHS Constitution.’

NICE VBP consultation response Pills