NHS England unveils revamp of cancer drugs fund

The arm’s length body said the fund needed to change because it was not financially sustainable in its present form.

The fund was set up in 2010 to provide access to treatments to patients who could potentially benefit from drugs that had not been approved by the National Institute for Health and Care Excellence.

Its budget was initially set at £200m but it has since ballooned to £340m.

Last week NHS England accepted a recommendation from the independent cancer taskforce for reform of the fund, which it said was “no longer sustainable or desirable… in its current form”.

In a board paper released this week, NHS England said current arrangements were “allocating an increasing share of the cancer budget to treatments that are less cost effective, towards the end of life, and the impacts of this are being felt further down the cancer pathway”.

The paper proposes a new model for the fund which “does not allow the budget to grow any further, recognising that other areas of investment will deliver greater benefits”.

In future the fund should become a “managed access” fund for new drugs, with “clear entry and exit criteria”.

It would be used to pay for drugs that lack sufficient evidence to warrant routine use, but which “appear promising” and could benefit from extra evidence “to enable a more informed NICE appraisal decision”.

Instead of a “failure to recommend”, these drugs would receive “conditional approval” by NICE and be provided through the fund “for a defined period”, during which further evidence from “real world” use would be collected.

At the end of the period the drug would go through “abbreviated NICE appraisal” using the new evidence and the manufacturer’s offer price.

It would then either be recommended by NICE, and move out of the fund into mainstream commissioning, or it would be rejected, in which case it would exit the fund and only be available through individual patient referral.

NHS England said its proposal would allow the money to be “more effectively managed” while providing a “new pathway for assessing innovative drugs”.

The Association of the British Pharmaceutical Industry welcomed the proposals.

ABPI director of value and access Paul Catchpole said: “This move should help provide a much needed bridge to greater reform of NICE so that all patients can benefit from improved access to new medicines.”

NHS England will develop its plans and put them to public consultation in September at the latest, with the aim of implementing the new fund from April 2016.

The national body acknowledged that its final proposal would have to be consistent with the “developing thinking” of the government’s accelerated access review, which is looking at speeding up the entry of innovative drugs into the NHS.

As reported by HSJ on Wednesday, Sir Hugh Taylor, the review’s chair, has said extending the principle of the cancer drugs fund to non-cancer drugs is one of the ideas it is considering.