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11 February 2016Big Pharma

From cradle to grave: pharma drug drive in the NHS

In April, the UK government is expected to publish the Accelerated Access Review. The report is intended to suggest a method of speeding up patients’ access to the latest medicines developed by pharmaceutical companies in the current restricted financial climate at the National Health Service (NHS).

Tasked with this job is Sir Hugh Taylor, an experienced civil servant with a number of years behind him working in the Department of Health. Last October, he published an interim report, which has been welcomed by many in the pharma industry.

The interim report is 26 pages long and centres on five proposals. One of the main suggestions is an increased focus on patient choice. Taylor notes that patients are increasingly “taking advantage of innovation, particularly in the digital sphere, to manage their own care across a range of conditions”.

He proposes that in order to build on patients’ thirst for knowledge about the drugs they are taking, they should be more involved at each stage of the development of the drug, so new avenues of dialogue between pharma and patients should be opened.

Furthermore, Taylor proposes to increase the speed at which the NHS takes on the latest drugs, by working closely with innovators and providing them with new options for funding arrangements, and to open up new pathways for a drug to be approved rapidly.

For pharma companies, he says, “the health system can appear—and in practice can be—an opaque, complex and discouraging environment in which to explore new ideas, launch a product or market it to scale”.

David Watson, head of commercial at the Association of the British Pharmaceutical Industry, says the interim report is a step in the right direction. In particular, he welcomes the emphasis on patient choice.

“There is less of an element of patient choice in the UK compared to other countries. We don’t have that approach in the UK. Patients are not as familiar with medicine brands or the originator company names,” he says.

From cradle to grave

Few institutions attract the affection of the UK population like the NHS. Established in 1948 to answer a need to expand healthcare to all regardless of their income, the NHS was the centrepiece of Clement Atlee’s Labour government. Governments have since been elected or broken on their record of running the institution.

“Of course GPs will treat ten people with a slightly less effective drug than one person for the same price who might get a slightly better result.”

Almost 70 years since it was founded, the NHS faces new pressures. Austerity is the ideology of today’s government and spending within the system has never been more scrutinised.

For pharma companies, developing patent-protected medicines and getting them prescribed by GPs working in the NHS can be difficult. According to Watson, the decision to prescribe a new drug on the NHS can go through as many as 6,000 to 10,000 people. On top of this, the NHS uses a higher proportion of generic drugs compared to branded products than its counterparts across western Europe.

“Every system has to balance that mix [between using branded and generic drugs]—the system simply couldn’t afford every medicine being a branded drug,” Watson says.

In addition to this heavy reliance on generics, there is a consensus among commentators that the UK has a particular problem with introducing patent-protected medicines into the service quickly.

“They tend to be adopted here much, much more slowly,” Watson adds.

With increasing financial challenges for the NHS in the next few years, the amount it invests in patent-protected drugs is likely to decrease.

A small cog

Jane Wainwright, partner at law firm Potter Clarkson, says that this should not have too much impact on pharma research.

“Compared to the US market, the NHS is much less relevant for innovator pharma companies. While the NHS not prescribing a drug due to costs will reduce sales, and therefore profits to some extent, I don’t believe it will drastically affect what research is done because the NHS is a small cog in a worldwide machine.”

She adds: “There has been a big push for doctors to prescribe without using brand names for a long while now, so I’m not sure there’ll be a big change based on a new push by NHS bosses.”

Patient choice is theoretically a good idea: a population armed with the knowledge of the latest drugs in development. Using that knowledge is tricky, however.

One tool used by patients in the last couple of years has been the internet, through which the phenomenon of self-diagnosis has grown exponentially as broadband was rolled out across the country. But this has its problems. Last week, Health Secretary Jeremy Hunt was taken to task by a number of doctors for recommending that mothers search online for ways to deal with dermatological problems. Their criticism lay in the fact that identifying illness is very complex and often requires professional help.

Spreading the word

Sally Shorthose, partner at law firm Bird & Bird, says it is difficult for pharma companies to promote certain products. She says pharma companies will start “awareness campaigns” about their research, but a lot of reporting on the developments won’t mention the brand name. This makes it harder for IP owners to establish their name among patients.

Awareness about drugs in the UK compared to the US is much lower, says Shorthose, attributing that to the different regimes in place: the US market is insurance-driven and provides more space for patient choice.

The NHS faces a number of challenges in the near future, such as ensuring it supplies the best drugs to patients at an affordable price. NHS bosses have constantly to navigate a tough political terrain.

But as Shorthose summarises, the problems for IP owners remain the same: “The manufacturing of a drug is so complex and the production takes a long time. Companies worry about the lack of blockbusters coming through, while there are effective generics that can treat problems.

“Of course GPs will treat ten people with a slightly less effective drug than one person for the same price who might get a slightly better result.”

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