Vary drug prices for different conditions, say health experts

The NHS could improve patients’ access to new cancer treatments by paying different prices for drugs depending on the disease they are used to treat, concludes a group of experts from across academia and industry.

The consensus panel, representing 16 leading academic institutions, charities, stakeholder groups and pharmaceutical companies, also called for the Government to consider tying prices of drugs to the benefits they deliver for patients.

Flexible pricing models to help make new medicines more cost-effective were among nine recommendations for faster and wider access to innovative treatments – drawn up following a summit held by The Institute of Cancer Research, London.

Members of the consensus panel included leading experts from the academic and charity sectors – The Institute of Cancer Research (ICR), UCL, Cancer Research UK and Breast Cancer Now – alongside sector organisations the Ethical Medicines Industry Group and the Faculty of Pharmaceutical Medicine.

The panel also included a group of leading pharmaceutical and biotech companies: Abbvie, Bionical Emas, Bristol Myers Squibb, Immedica, Incyte Biosciences UK, Janssen, Merck, Pfizer, Roche Products Ltd and Sanofi.

The group’s nine-point plan recommended varying a drug’s price according to ‘indication’ – meaning a particular condition for which a treatment is approved. That way, companies could reduce the price of a drug for a certain disease, where it would otherwise not be cost-effective, without having to do so across the board.

“Being able to vary a drug’s unit price or apply discounts across multiple indications could encourage companies to bring drugs to market for new conditions, increasing access to treatments in areas of unmet need,” the experts said.

The consensus group also backed proposals for the NHS to only pay the full agreed price for a drug when it delivers the anticipated benefits. So-called outcome-based pricing would be “a promising way of ensuring the NHS gets value for money for innovative new cancer medicines while providing access to the newest and most exciting treatments for patients”, the panel said.

Members of the panel advised that the NHS would need better infrastructure if it was to collect the detailed prescribing data required to support new models of drug pricing. “We recommend that the Government and pharmaceutical industry work together to expand the necessary digital infrastructure and personnel, so drug prices can be aligned with outcomes or varied by indication,” they said.

The nine statements, published today (Monday) by the ICR, represent areas of cross-sector agreement on how to give patients better access to innovative drugs at prices the NHS can afford – in order to counter the major clinical challenge of cancer evolution and drug resistance. At the moment, it can take years for new drugs to be authorised by regulators and approved for the NHS.

The recommendations aim to build on a range of initiatives introduced over the past five years to try to ensure that new drugs reach patients faster, including the Accelerated Access pathway for innovative treatments, and improvements in the use of the Cancer Drugs Fund when NICE took it over in 2016.

There is an opportunity to enshrine variable pricing within the replacement for the current Voluntary Scheme for Branded Medicines Pricing and Access, a five-year agreement between the Department for Health and Social Care and the Association of the British Pharmaceutical Industry (ABPI) set in 2019.

Other recommendations set out in the consensus statements include:

• On collaboration: “We strongly urge the Competition and Marketing Authority to issue clear guidance within existing legal arrangements to make it easier for companies to collaborate on potentially life-saving new combination treatments – which will be essential for overcoming cancer evolution and drug resistance.”
• On innovation: “We believe a drug’s degree of innovation in its mechanism of action should be properly considered when evaluating new treatments for use on the NHS.” This will also be key to overcoming cancer evolution and drug resistance.
• On ‘biomarker’ diagnostic tests used in tandem with specific drugs: “We call for a clearer route for diagnostic tests to reach the NHS alongside new treatments, for example by adding new tests to the directory as drugs are approved.”
• On new effectiveness measures for drugs tested in clinical trials: “Waiting for clinical trials to show an overall survival benefit can take a long time and cause unacceptable delays for patients in accessing new treatments. We believe the public and private sectors should collaborate on dedicated research to investigate the accuracy of surrogate measures in predicting future survival benefit.”

Professor Paul Workman, Chief Executive of The Institute of Cancer Research, London, said:

“We need fundamental change to the systems for making new cancer drugs available – so that the amazing discoveries we’re seeing in our scientific understandings of cancer can be translated into advances in treatment as quickly as patients deserve. Innovative drugs and combinations are essential to overcome the major challenge that we face in cancer treatment – which is to overcome cancer evolution and drug resistance.

“Innovative new drugs are taking too long to be approved for patients, partly because regulatory systems haven’t kept pace with the science, and partly because new drugs are so expensive it is hard to show they can be cost-effective. We believe one way of solving that is to offer more flexibility in the pricing of innovative new drugs, so there could be discounts for certain conditions, or full prices only paid if drugs prove as effective as their manufacturers have claimed.

“The nine-point plan we release today shows there is broad agreement across sectors involved in drug discovery and development on what the major issues are that we must tackle, and how improvements can be made. I call on the Government, and decision makers in the NHS and industry, to instigate vital changes that will speed up access to drugs for patients.”

Marcia Philbin, Chief Executive of the Faculty of Pharmaceutical Medicine said:

“The Faculty of Pharmaceutical Medicine’s vision is “A world where effective medicines meet the needs of patients”. Only by working together will we be able to address the underlying factors that prevent cancer patients accessing much needed new treatment. The work undertaken by the ICR in collaboration with other bodies is a great example of how to effect that change.”

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Notes to editors

For more information please contact Henry French in the ICR press office on 020 7153 5313 or henry.french@icr.ac.uk. For enquiries out of hours, please call 07595 963 613.

Here are the nine consensus statements in full:

1. We support work to explore ways to tie a drug’s price more closely to the outcomes it delivers for NHS patients. We see this as a promising way of ensuring the NHS gets value for money for innovative new cancer medicines while providing access to the newest and most exciting treatments for patients.
2. We recommend that the flexibility to vary the price of drugs for different indications be explored when the next medicines pricing deal is negotiated. Being able to vary a drug’s unit price or apply discounts across multiple indications could encourage companies to bring drugs to market for new conditions, increasing access to treatments in areas of unmet need.

3. The NHS lacks the infrastructure to collect the robust and detailed prescribing data needed to support new models of drug pricing. We recommend that the Government and pharmaceutical industry work together to expand the necessary digital infrastructure and personnel, so drug prices can be aligned with outcomes or varied by indication.
4. We are concerned that competition law is preventing companies from working together to take innovative drug combinations to the market, by making it more difficult to share the prices of drugs. We strongly urge the Competition and Marketing Authority to issue clear guidance within existing legal arrangements to make it easier for companies to collaborate on potentially life-saving new combination treatments – which will be essential for overcoming cancer evolution and drug resistance. If necessary, we believe exemptions should be written into the relevant legislation.
5. We believe diagnostic tests for biomarkers are key to advancing precision medicine and want to see them used as standard with new targeted treatments. Current plans to only update the National Genomic Test Directory annually could lead to delays of many months before the latest tests are available on the NHS, with potential knock-on impacts on drug access. We call for a clearer route for diagnostic tests to reach the NHS alongside new treatments, for example by adding new tests to the directory as drugs are approved, to open up faster access to the latest biomarker tests.
6. Waiting for clinical trials to show an overall survival benefit can take a long time and cause unacceptable delays for patients in accessing new treatments. We believe that the public and private sectors should collaborate on dedicated research to investigate the accuracy of surrogate measures in predicting future survival benefit, to support licensing bodies and NICE in making more flexible decisions on evidence.
7. We believe a drug’s degree of innovation in its mechanism of action should be properly considered when evaluating new treatments for use on the NHS. It is vital that we give patients access to innovative new treatments that attack cancer in brand new ways, since these are most likely to deliver step-change advances in treatment, especially as part of drug combinations.
8. We call for greater cooperation between the public and private sectors in delivering research dedicated to the discovery and development of drugs for cancers of particularly high unmet need. We need to consider how new incentives or other Government interventions could strengthen research activity in those cancers where survival remains very poor.
9. We support efforts to develop a simple online portal for the health innovation ecosystem to provide access to a wide range of information for those working in the life-science sector. We commend the work of the Accelerated Access Collaborative in developing this resource, and recommend that it includes information and signposting on funding sources, regulatory processes and schemes to fast track new drugs – as a means of getting innovative treatments to patients as quickly as possible.

The Institute of Cancer Research, London, is one of the world’s most influential cancer research organisations.

Scientists and clinicians at The Institute of Cancer Research (ICR) are working every day to make a real impact on cancer patients’ lives. Through its unique partnership with The Royal Marsden NHS Foundation Trust and ‘bench-to-bedside’ approach, the ICR is able to create and deliver results in a way that other institutions cannot. Together the two organisations are rated in the top centres for cancer research and treatment globally.

The ICR has an outstanding record of achievement dating back more than 100 years. It provided the first convincing evidence that DNA damage is the basic cause of cancer, laying the foundation for the now universally accepted idea that cancer is a genetic disease. Today it is a world leader at identifying cancer-related genes and discovering new targeted drugs for personalised cancer treatment.

A college of the University of London, the ICR is the UK’s top-ranked academic institution for research quality, and provides postgraduate higher education of international distinction. It has charitable status and relies on support from partner organisations, charities and the general public.

The ICR’s mission is to make the discoveries that defeat cancer. For more information visit http://www.icr.ac.uk