In response to a recent article by Polly Toynbee describing NHS drug pricing as a 'special circle of hell', Andrew Dillon, former chief executive of the National Institute for Health and Care Excellence (Nice), has outlined ways to improve the system. Writing in a letter, Dillon acknowledged the challenges but suggested that better negotiation with pharmaceutical companies could make a significant difference.
Dillon noted that new drugs are never cheaper than those they replace, so the NHS must ensure they offer better outcomes. While a few drugs revolutionise treatment, most provide incremental improvements in quality and length of life. Nice recommends the great majority of new medicines, but spending on them diverts cash from other NHS services. To manage this trade-off, Nice uses health economics and frequently flexes its value-for-money threshold to facilitate access to promising treatments.
After Nice recommends a drug, companies face slow adoption by the NHS and a separate price cap mechanism negotiated between the industry and government. Dillon proposed three changes: first, an independent review of the value-for-money threshold with implementation of its recommendations; second, Nice setting take-up rates for recommended drugs with NHS commitment to achieve them; and third, companies engaging early with Nice and offering a realistic price upfront, in return for a special deal on the price cap.
