Health secretary backs ‘easier’ medicines access system

The way decisions are made on prescribing medicines not deemed cost-effective will be simpler in future, according to the health secretary.

Health boards will decide whether or not to pay for a drug or treatment based on the “likely medical benefits” from September.

Previously, patients had to demonstrate they were “exceptional” cases.

Vaughan Gething said the review would help health boards deal with “sensitive and very often complex decisions”.

But expert panels will still need to consider whether particular treatments provide value for money, which according to Mr Gething will recognise “the NHS is not an infinite resource”.

Mr Gething, who will outline his position to assembly members on Tuesday, said the review had made “thoughtful and pragmatic recommendations” which had put the patient’s voice at “centre stage”.

Each year, hundreds of new drugs and treatments are developed but the NHS cannot afford to pay for them all.

An independent review, set up last summer, aimed to improve the way patients apply for medicines not routinely provided by the NHS due to cost.

These applications, via the Individual Patient Funding Request route, are considered by separate panels in each health board consisting of clinical experts and managers.

Critics have argued panels were more likely to approve some treatments than others, creating a “postcode lottery”.

The review’s findings, published in January, found that the “exceptionality” principle was not well understood and had been applied in circumstances where it did not make sense.

It believes key decision-making criteria should be what the clinical benefits of medicines are and whether the treatment offers reasonable value for money.

“The good news from the report is that many aspects of the system are working well and the review group have made helpful recommendations to strengthen those and improve upon other aspects of the process,” Mr Gething said.

A new £80m fund to help patients in Wales with life-threatening illnesses get quicker access to new medicines has already been confirmed.

Mr Gething said the recommendations would be easier to understand but that medicines would still have to “deliver reasonable value”.

He said that there would still be occasions where a treatment was potentially effective but that the NHS simply could not afford to pay.

“Sometimes we’ve shied away from that,” he added.

“But if there’s a treatment that costs £1m for an individual – that’s money that can’t be spent on a range of other people.”

‘Time for delivery’

While welcoming the ambition to make the system clearer and simpler to understand, some charities called the changes a “missed opportunity” to make real improvements.

Plaid Cymru’s health spokesman Rhun Ap Iorwerth said he was looking forward to the government response.

“Securing this review was important for hundreds of patients who have to go through this process each year but now is the time for delivery on the changes recommended,” he said.

“Replacing the unfair ‘exceptionality’ test with a ‘significant clinical benefit’ test will help more patients obtain the treatment they need.”