Expert advice

Medicines management: How can I advise a patient who would benefit from medicine not available on the NHS?

I have a patient who would benefit from a medicine not available on the NHS. Is there any advice I can give?

Question: I have a patient who would benefit from a medicine not available on the NHS. Is there any advice I can give?

Any advice depends on the medication the patient requires, as well as the condition they want treated.

In 2010, the government set up the Cancer Drugs Fund (CDF) to address negative press about cancer patients being refused drugs for their conditions.

It was announced this year that the CDF will be extended, but some drugs have been ‘delisted’. Some of these will have been approved by the National Institute for Health and Care Excellence – which looks at the cost and clinical effectiveness of medicines – but some may have previously been rejected. With more therapies coming to market in the midst of limited NHS resources, it is becoming increasingly difficult for NICE to approve medicines.

For medicines outside of cancer therapies, we rely on NICE for guidance but clinical commissioning groups (CCGs) decide on their own local formularies. If medicines have been approved by NICE, this is relatively straightforward, but if there is limited evidence about the cost and clinical effectiveness of medicines, they would need to go through an exceptional funding application.

Independent review panels for exceptional funding applications consider the evidence provided in such cases, such as proof of efficacy and cost. If medicines are not part of a CDF list, are not approved by NICE and fail to be accepted by an exceptional funding applications review panel, the drugs cannot be provided with NHS funding. In these cases, the patient has no option but to obtain their medicines through private routes. This may seem unfair, but if medicines look like they may make a difference, the case can be appealed if there is evidence to support the application.

The NHS is limited by the funds available, and treating one person with an expensive drug may mean cutting other services.

About the author

Matt Griffiths is visiting professor of prescribing and medicines management at Birmingham City University

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