All NHS organisations have been ordered to publish details of which drugs they will routinely fund in a bid to make sure patients get medicines they are legally entitled to.
NHS chief executive Sir David Nicholson has given trusts and clinical commissioning groups until next April to reveal which drugs approved by the National Institute for Health and Clinical Excellence are included in their formularies – the list of drugs their clinicians are allowed to prescribe.
By law the health service is required to automatically fund all drugs recommended by NICE. However, this does not always happen in practice.
In a letter to primary care trust and strategic health authority chief executives and CCG leaders informing them of the new requirement, Sir David said local formularies should not “duplicate NICE assessments or challenge an appraisal recommendation”.
He added: “Once on formularies, there should be no further barriers to the use or prescription of technologies or medicines.”
In an article for HSJ last month, NICE chair Sir Michael Rawlins criticised formulary committees for not complying with NICE technology appraisals. He claimed patient access to new products was regularly delayed by arguments between PCTs and providers about whether the costs were covered by the contract.
Speaking to HSJ, Sir Michael welcomed the new approach set out by Sir David.
He said: “This should give a very positive result. I don’t think trusts will dare leave any [NICE approved drugs] out; it will be too glaringly obvious that they are breaking the law. There will be lots of people checking, including patient organisations and pharmaceutical companies.”
Asked about criticism that NICE technology appraisals do not take into account the financial situation within the NHS, Sir Michael said that was not an issue for NICE.
“It’s the law the NHS provides these drugs. Until that law is changed they have to obey the law,” he said.
David Stout, deputy chief executive of the NHS Confederation, said it was “absolutely right” that patients should get the treatment they were entitled to under the NHS but warned NHS organisations had a “finite” amount of money available.
He added: “We need to be open and honest with the public about what the consequences of this financial challenge are, and the fact that trade-offs will be required if we are to improve standards of care while keeping the NHS affordable.”
The letter follows a commitment in the Innovation, Health and Wealth review to introduce a Compliance Regime for NICE technology appraisals. The requirement to publish which appraisals are included in a formulary will be a standard part of NHS contracts from April 2013.
Stephen Whitehead, chief executive of the Association of the British Pharmaceutical Industry, said he was “greatly encouraged” by the letter.
He added: “The publication of NICE technology appraisals included in local formularies is a positive step that will inform stakeholders and the general public of progress in adopting innovation, and in the long run, will lead to improvements in health outcomes.”