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Cancer Drugs Fund is here to stay

By Darren Fergus

There’s a Five-Year Forward View in NHS England and industry should adapt to the FYFV as it’s trendily called.

No kidding Sherlock.

I’ve recently read 2 independent blogs amplifying this advice to the pharmaceutical industry, seriously?

Why don’t we take fresh forward views of the situation in NHS England and lets starts by focusing on an area very close to my heart, cancer care?

Why Health will put its strategic goggles on to give a clearer view elsewhere in the NHS, for example mental health, but let’s start by looking at cancer care and answering the question on many people’s minds, will the Cancer Drugs Fund exist in the next parliament?

In my early marketing career the communications team hadn’t tired of exploiting headlines such as ‘Postcode Lottery’ and ‘NICE Blight’, but all that changed in 2011. The coalition government introduced a £280m Cancer Drugs Fund to pay for new medicines rejected by NICE and for a few months everyone was happy.

However, happiness is often short-lived in the world of government affairs and in January 2015 NHS England announced its very difficult decision to remove 25 of the drug licences currently paid for from the CDF. For NHS England this made it slightly easier to prop up the CDF, but for every company like my old employer, unhappiness was the prevailing wind.

What’s more, the new prevailing wind carries judicial reviews and the inevitable implications of bitter court battles. Industry is challenging some of the decisions announced in January and the working relationship of NHS England and industry is likely to come under increasing strain. Not many divorced couples talk fondly of their bitter court battles in the divorce courts of the UK. I doubt NHS England will look back upon this process with fondness either. However, my view is that whichever way these reviews go NHS England will ultimately come out on top. For most divorcees, it gets a lot easier to say no to their past partners after the dust has settled. Post-judicial review it is very likely that NHS England will feel a little more comfortable saying no to its old pharmaceutical partners coming forward with expensive new cancer treatments.

The CDF is an old pre-election sticky plaster put on by the Conservatives and trying to take a long-term view of a short-term solution is next to impossible.

Labour is dangling the carrot of raising the cost-effectiveness threshold over £30,000 and threatening to call the CDF the CTF, or Cancer Treatments Fund. Whist the rebranding doesn’t cause any headaches; NICE may not thank Andy Burnham for potentially making it even more difficult to approve new treatments already funded by the proposed CTF.

If only NICE had been launched by the Conservatives, quietly dissolving the CDF into the NICE appraisal process would be a lot more palatable. Nobody likes to eat his or her own carrot. Nobody likes to admit that they’re the cause of their own headache; it’s like banging your head against a brick wall and saying you’re shocked that it hurts.

The Conservatives will keep the CDF.

Why Health asked Dr Daniel Poulter, Parliamentary Under Secretary of State at the Department of Health, if the CDF would exist for the term of the next parliament, assuming the Conservatives are re-elected? Dan Poulter replied, “Yes”.

Industry faces bigger headaches than the CDF cutting 25 drug licences, or the short-term posturing about when and how NICE could swallow the CDF whole?

Industry has recently been awarded early access to new drugs.

The first medicine to be approved through the UK’s Early Access to Medicine Scheme has been named, which means a big launch party for the pharmaceutical company concerned. However, hangovers follow every party and this one could be massive. Sufficient data to receive a Promising Innovative Medicine designation is a far cry from robust data suitable for the CDF or NICE appraisal processes, which could mean an unexpectedly patient product launch in the long term.

One things for certain, when you add in another appraisal process the lunar alignment of the EMEA, EAMS, CDF and NICE becomes more of an eclipse. Industry faces the real headache of even more complex technology appraisals and is often underequipped to treat this, because the headache comes as a consequence of the phase III clinical trial protocols of the past.

What options are there for company’s offering innovative treatments for cancer patients?

Early phase discussions are mission critical, particularly when your goal is to address unmet patient needs. Easier said than done, which is why we often see data gaps coming out of phase III clinical trials. Nowadays, over half of your phase III clinical trials planning should ideally be aimed at addressing the health economic needs of the populations you plan to serve.

Put cancer patients first and mean it and you are already aligned with NHS England; yes, NHS England is the people who deliver a great service and get out of bed in the morning because they want to do a better job for the patients they serve. But what does this really look like for the pharmaceutical industry? Putting cancer patients first and releasing the full value proposition for your product means thinking beyond the CDF or NICE. Receiving reimbursement for your new cancer treatment within the duration of your strategic marketing plan is one important thing, but sustainable product performance comes from putting patients first and meaning it.

Why Health is a specialist healthcare agency and our thinking goes beyond the CDF appraisal process, which is here to stay for another 5 years at least. It even goes beyond the NICE appraisal process, which is often the envy of the world.

Our thinking at Why Health goes into what patients need first, then we work backwards from this premise to identify everything that needs to happen.  Making sure each step along the way leads to giving patients everything they need, precisely at the time when they need it most.

This is our Whole Patient Proposition and something the pharmaceutical industry can benefit from; because we must not forget the CDF is still a short-term solution.

Putting patients first and really meaning it is the long-term thinking we need.
Why Health is a specialist healthcare agency
Not your run of the mill medical education agency or market access consultancy, because at Why Health we don't exist in isolation. Your marketing plan doesn't sit in silos and neither do we. At Why Health we specialise in bringing an holistic approach to you, working in parallel with your marketing plan to deliver everything you need.
That's why we are a specialist healthcare agency.
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