Why the uptake of innovative medicines matters now more than ever
Everywhere this author looks, it is clear: the NHS is in crisis. Waiting times have skyrocketedi, ambulance delays are the worst on recordii, and NHS staff are ‘petrified’ of how bad this winter will be in England.iii One cannot help but wonder how long this ‘new normal’ will last. From a patient access point of view, it’s as if we’ve had collectively to lower our ambitions from calling for access to innovative medicines, to simply access to healthcare.
Against this backdrop, it was a welcome development to see a voice rise against the tide yesterday, as the Association of the British Pharmaceutical Industry (ABPI) and NHS Confederation published a report on the importance of equitable access to innovative medicines.
Their report, Transforming lives, improving health outcomes: tackling the true cost of variation in uptake of innovative medicines, identifies some of the complex structural and operational barriers leading to unwarranted variation in uptake. It argues that there is considerable variance in the uptake of NICE-approved medicines – 59%, between London and Wales – and that the UK is falling behind its European counterparts. 13 recommendations are set out to begin addressing this problem, including “a clear national policy statement on improving access to innovative medicines,” which could be backed by something similar to Wales’ recent initiative of a New Treatment Fund, to speed up access to life-improving medicines.
The sheer range of recommendations – across government, national and regional NHS leaders – confirm there is not a clear or single solution to the problem. But we are reminded of the great progress that pharmaceuticals have achieved, and the importance of continuing to be ambitious.
With little focus in the report on the work of NICE, it seems it is uptake, not access, that remains the weakest link to ensuring patients benefit from our rich innovation ecosystem. A study by PwC and the ABPI notes that 1.2 million patients are missing out on access to innovative treatments across four medicine classes alone – stroke prevention, kidney disease, asthma and type 2 diabetes. iv Access to these medicines “could bring significant economic benefits to the UK, in addition to wider individual and community benefits for patients, carers and families”.v
However, the devil is in the detail, and questions remain about the execution of the ambition articulated by the ABPI and NHS Confederation: how can the system deliver on the 13 recommendations set out? For example, the call for ‘reform of rigid pathway structures’ might contradict precisely the rigidity upon which NICE depends for its decision making. What evidence is being used to back up the claims made about innovative medicines’ role in improving health outcomes? As ever, this debate warrants more data not less. Finally, what should manufacturers themselves be doing to ensure greater and more equal access?
This relatively unusual partnership between industry and a leading NHS organisation is welcome and active engagement by both is clearly fundamental to progress.
By Cristina Ruiz de Villa