Clinical commissioning groups across England are mulling the use of an unlicensed drug which could save the NHS millions of pounds, HSJ has learned.

Vale of York and Northern, Eastern and Western Devon CCGs are hoping to switch from Lucentis to Avastin for the treatment of age related macular degeneration, as are a number of other CCGs across the North East.

While both drugs are closely related, Avastin is listed at a 10th of the price of Lucentis.

The cheaper drug is licensed by the Medicines and Healthcare Products Regulatory Agency for the treatment of five cancers in their advanced stages, including breast and lung cancer but is not licensed for use in the eye.

Controversy over its use to treat age related macular degeneration has raged for years.

In 2012, Novartis which markets the drug in the UK, launched a judicial review of a primary care trust cluster’s plans to mandate its use.

CCGs have revisited the issue after a Cochrane review concluded that use of the cheaper drug was safe.

Vale of York chief clinical officer Mark Hayes told HSJ the main barrier to the routine use of Avastin in the UK was the General Medical Council’s code.

This stipulates that doctors should not use unlicensed drugs unless they think it is the best option for “medical reasons”.

“Absolutely everyone knows [using Avastin] is the right thing to do but clinicians are afraid of the GMC and the government don’t want to upset the drug companies,” he said.

“The finances of the NHS now mean we have to do something about this.”

Dr Hayes said Avastin was available for a 10th of the Lucentis £600 listed price.

While HSJ understands Lucentis is offered at a significant discount on the list price, the CCG estimates it could save £4m annually by switching to the cheaper drug.

The Health and Social Care Information Centre estimates the NHS spent almost £244m on Lucentis in 2013-14, the second largest amount the NHS spent on a drug.

Vale of York CCG is due to be asked next week to approve the preparation of a business case for the provision of an Avastin only service from next April.

The move is also one of a raft of initiatives being considered by NEW Devon as part of its drive to find £26m of in-year savings.

Alistair Blair, an NHS Clinical Commissioners board member and chief clinical officer of Northumberland CCG, said lots of CCGs in the North East were also looking into the issue.

Dr Blair told HSJ that one approach under consideration was informing patients of the cost difference and allowing them to make a choice.

“I can’t see many patients saying they want the more expensive drug if you look at the evidence available,” he said.

Only manufacturers can ask regulators to consider licencing a drug for the treatment of particular conditions.

Roche, which owns the patents for both drugs, has not done so.

In a statement, the company said it was not licensed because it had not been “developed and manufactured to meet intraocular standards”.

However, in February this year Novartis and Roche were each fined more than €90m by the Italian Competition Authority for colluding to maintain an “artificial distinction” between the two drugs.

In 2010 the National Institute for Health and Clinical Excellence recommended the Department of Heath request an appraisal of Avastin for the treatment of wet age related macular degeneration.

NICE cannot consider this until the DH makes a formal referral, which it is yet to do.

During health questions in the Commons on Tuesday, minister for life sciences George Freeman said the decision to prescribe unlicensed drugs was for clinicians.

“I don’t think it’s right that the government gets into the position of effectively sponsoring new licencing requests,” he said.

A spokeswoman for the GMC said its guidance was “consistent with European law” which states that “it is unlawful to prescribe unlicensed medicines - including for a condition not covered in the license - on the grounds of cost”.

“Clearly we cannot issue guidance that might lead doctors to act unlawfully,” she added.

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