16 December 2013
In May 2013, the Minister for Health and Social Services commissioned a review of the appraisal of orphan and ultra-orphan medicines in Wales. These are medicines indicated in the treatment of rare and extremely rare conditions.
Early in 2013, the Scottish Government launched a £21 million fund to cover the cost of medicines, not available for routine prescription, for individual patients with rare conditions. In October 2013, as part of an on-going review into access to new medicines, the Scottish Government announced an extension of its Rare Conditions Drugs Fund until 2016.
England’s Cancer Drugs Fund, established in 2011, routinely funds a number of cancer medicines not otherwise available on the NHS. Additionally, the Fund receives requests for medicines to treat individuals with rarer types of cancer. The Cancer Drugs Fund was intended as an interim measure until a new pricing system for medicines was brought in at the beginning of 2014. The new ‘value-based’ pricing system has not developed quite as originally envisaged, and in September 2013 it was announced that the Cancer Drugs Fund in England was to be extended for a further two years until 2016.
The Welsh Government has continued to resist calls for a similar fund in Wales, arguing that spend per head on cancer in Wales is greater than that in England. The First Minister recently stated:
… we know now that the cancer drugs fund is nothing more than a confidence trick. I will explain why I say that. Of those who apply for funding to the cancer drugs fund, more than 70% are refused. For the equivalent in Wales, the individual patient funding requests, which are open to people with all conditions, not just those with cancer, more than half of the applications are accepted.
The report of the Welsh orphan drugs review was published for comment on 11 November 2013. It recommended that there should not be a separate orphan/ultra-orphan medicines fund in Wales, and that the appraisal of these medicines should remain within the framework of the All Wales Medicines Strategy Group (AWMSG).
The Review highlighted that access routes for orphan and ultra-orphan medicines need to be simplified and streamlined, and made a number of recommendations in relation to the appraisal process, assessment criteria used and ensuring equity of access. The Review stated:
There cannot be a guarantee that all medicines approved for use in England will be approved for use in Wales. Different methods across UK may result in difference in recommendations. Of greater importance is that there is fairness and equity across Wales.
The Welsh Government’s Health Technologies Fund was established earlier this year to support investment in innovative medical technology. While the Fund may enable patients to access some (non-drug) treatments not otherwise available in Wales (for example, robot surgery for prostate cancer), written evidence received for the Health and Social Care Committee’s inquiry into access to medical technologies emphasised that the existence of such a Fund in no way replaces the need for a robust appraisal and procurement system for technologies across the board. It’s suggested that to improve access to new medical technologies, an approach similar to that taken for medicines in Wales is needed. The Committee will begin taking oral evidence for its medical technologies inquiry in the new year.