Increasing the threshold the NHS pays for drugs would make it easier for patients to access more expensive drugs – but could mean the health service pays more for medicines overall
Weight loss treatments and a life-saving breast cancer drug could be available to NHS patients under a new plan to stave off tariffs threatened by US President Donald Trump.
A proposal to counter Trump tariffs by raising the threshold used by England’s NHS spending watchdog by 25 per cent – therefore raising the amount the NHS pays pharmaceutical firms for drugs – has been briefed to Washington officials, according to reports.
The Government has confirmed it is in “advanced discussions” with the US to “secure the best outcome for the UK”.
Experts have warned that the move would mean the health service pays more for medicines overall – and therefore could harm overall patient care.
But increasing the threshold would make it easier for patients to access more expensive drugs not currently approved for the NHS due to their cost – including cancer treatments – as well as weight loss drugs.
Millions of people have been forced to pay for anti-obesity treatments privately in recent months because the health service does not have enough money to meet demand.
Although Wegovy and Mounjaro injections have become available on the NHS their rollout has been limited to ensure medics are not overwhelmed.
Health Secretary Wes Streeting has also indicated that he wants to see weight loss pills made available on the NHS – but questions are already being asked about affordability.
The head of Breast Cancer Now told The i Paper the proposals could mean women soon have access to drugs such as Enhertu, which has been rejected for HER2-low secondary breast cancer on grounds of cost-effectiveness.
Enhertu, can give patients with a specific type of incurable breast cancer an extra six months to live on average. The health assessment body, the National Institute for Health and Care Excellence (Nice), is the only organisation around the world so far to say no to the drug for this condition – despite being already available in 19 countries in Europe, including Scotland.
Nice assesses medicines based on a number of factors including clinical effectiveness, cost effectiveness and the overall cost to the NHS. This is done using an assessment called quality-adjusted life years (QALYs), which combines both the length of life gained from a treatment and its impact on quality of life, represented as a number.
In general, Nice considers medicines costing between £20,000 and £30,000 per additional QALY gained to represent good value for money for the NHS. Raising the threshold makes it more likely Enhertu and similarly expensive drugs could be approved for NHS use.
Claire Rowney, chief executive at Breast Cancer Now, said: “If the Government were to significantly increase the cost-effectiveness threshold for medicines, this could be a game-changer that sees more people getting access to vital life-extending treatments.
“Crucially, this change could mean the NHS is able to pay more for some medicines, including drugs for incurable secondary breast cancer that could give people more time to live and be there for the moments that matter.
“For too long cost-effectiveness thresholds have jeopardised the approval of some groundbreaking new medicines. Just last year patients faced the devastating blow of Enhertu being rejected for HER2-low secondary breast cancer on grounds of cost-effectiveness, potentially cutting thousands of women’s lives short.
“We’ve been urgently calling for secondary breast cancer patients to get access to the drugs they so desperately need and deserve – and if these proposals were adopted they could help pave the way for making this a reality.”
The reported changes would apply to NICE decisions made in England, with Wales and Northern Ireland usually adopting the same decisions.
A pharmaceutical expert said that setting a higher threshold would mean that future weight loss treatments could also be more likely to become available on the NHS.
“Some 90 per cent of drugs assesed by Nice are approved for use on the NHS. So if you raise the threshold by 25 per cent then it is inevitable more drugs will be approved, which could include weight loss drugs.”
But he added: “The NHS only has a limited budget, so if it wants to spend more money on drugs then the Government will have to give it a lot more money [to pay for those extra drugs].”
The head of the National Pharmacy Association (NPA) said he hoped any change can make it easier for pharmacies to deal with the consequences of chronic supply shortages.
Olivier Picard cited ongoing issues with Estradot, a HRT treatment, Cefalexin, an antibiotic for pneumonia, and Creon – arguably the most acute and serious drug shortage in the UK – where a permanent solution needed to be found.
NPA Chair Olivier Picard told The i Paper: “It’s important pharmacies who are at the sharp end of these problems are fully supported by the government to meet any increases in the costs they incur in sourcing medicines their communities rely on.”
However, scientists pointed to recent research which has showed that raising the threshold would wean the UK has to reallocate resources away from other patients’ care.
“For every £40,000 we spend we get one year of good-quality life, but for every £40,000 we take away from those other patients we lose two years of good-quality life, a net loss of one year of good-quality life,” said Ed Wilson, Professor of Health Economics and Health Policy at the University of Exeter.
“So saying ‘yes’ to the new treatment has harmed the net health of patients. All choices involve trade-offs.
“If the UK wishes to pay more for drugs to support the life-sciences industry, then it has to be clear and honest as to the cost of this to NHS patients: somewhat ironic given the objective of the industry should be to improve the lives of patients.”
Science minister Lord Patrick Vallance conceded an increase in the price the NHS pays for medicines will be “necessary” to prevent pharmaceutical investments from continuing to leave the UK.
Major firms have shelved or paused planned UK pharmaceutical industry investments this year, and industry bosses recently told MPs a “difficult” environment and pressure on pricing had made Britain a less attractive investment environment than other countries such as the US.
It is understood Trump wants more parity on drug pricing, with drug prices in the US higher than anywhere else in the world, and he has threatened to impose tariffs of up to 100 per cent on pharmaceutical imports.
A Government spokesperson said: “The pharmaceutical sector and the innovative medicines it produces are critical to our NHS, our economy and the Plan for Change. Through our Life Sciences Sector Plan, we’ve committed to working with industry to accelerate growth in spending on innovative medicines compared to the previous decade.
“We’ve secured a landmark economic partnership with the US that includes working together on pharmaceutical exports from the UK whilst improving conditions for pharmaceutical companies here. We’re now in advanced discussions with the US administration to secure the best outcome for the UK, reflecting our strong relationship and the opportunities from close partnership with our pharmaceutical industry.”
A Nice spokesperson said: “In a health system such as ours funded by general taxation, it is for the Government to decide how much to spend on health in the context of other spending priorities within the health system and beyond. In that context Nice is aware of on-going discussions in Government over the level of medicine spend.”