The Evil Tariff…Is treatment rationing coming to a Trust near you

General practitioners have been put in control of their budgets and they do what they can to spend as little money as possible. MS drugs are so expensive that they have been centrally funded by NHS. 

NHS England has been paying for the costs of MS drugs…but in a little published deal this may change and the costs may be pushed onto the Hospital Trusts with an enhanced Tariff.

The deadline for providers to choose between the Enhanced Tariff Option (ETO) and Default Tariff Rollover was 4 March 2015. 210 out of 241 NHS trusts and foundation trusts (87 percent of all NHS providers) will move to the new voluntary tariff option for 2015/16

What does this mean?

“Commissioners will now withhold 30 per cent of the value of care…(things including high cost drugs….) above a provider’s agreed baseline. These funds must continue to be spent on managing the demand for care, and for the avoidance of doubt, this investment decision must continue to be co-ordinated with other decisions made by commissioners on demand management”.

So as I understand correctly if Hospital trusts exceed their current budget they will have to pay for 30% of the costs of the drug. So are they going to want to spent about £10,000 to put someone on Alemtuzumab or ocreluzimab. Will it lead to drug rationing?

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  • The government has to live within its means – otherwise we end up like Greece. Last night on TV was an item about a new drug for Duchenne's muscular dystrophy. The drug lenghts the time before the child needs a wheelchair. The cost of the drug £155,000 to £200,000 a year. When I had my Campath infusion it cost a few thousand pounds, now repackaged as Lemtrada the two couses of infusions are over £50,000. The CEO of Biogen got £24m last year. Look at all the sponsorship of the MS conferences. Look at the nice consultancy fees paid to neuros for work on MS drugs. Drugs companies do not make looses – they make some of the highest returns. My solution – western european governments pay for the trials of oral cladrine to get it licenced. It can then be manufactured cheaply by a generic drug companies. Neuro have to prescibe this drug unless there is a compeling case not to. The savings from not prescribing the injectibles / orals would be huge. Some of these savings would pay for trials of neuro-protectants e.g. repurposing existing drugs. Unfortunately there would be losers – drugs company profits would fall, neuros coild no longer line their pockets with consulancy fees etc., no more MS conferences sponsored by drugs companies. Stop bashing the NHS for having to make decisions on what drugs can be offered – it's the extortionate prices which force this not the party on government.

    • Thanks a well structured response….I wonder if we could get your idea put into practise…however i think the view held by neuros is that cladribine is a scary drug. Could this idea change?

    • However, the issue of cost is a problem a d we are going to have to find ininovative ways to mitigate this

    • Good post. I do wonder whether re Cladribine there is a feeling in governments that to undercut the market is in some way anti business. What is clear that the outrageous price charged for MS drugs currently (even the rubbish ones) cannot be allowed to continue.

    • "What is clear that the outrageous price charged for MS drugs currently (even the rubbish ones) cannot be allowed to continue." Please define what current MS drugs are rubbish. Clearly the clinical trial data would say otherwise.

  • Anyone that has been treated or cared for by a specialist hospital, will have an idea how they're keeping within budget. You are asked to go to your GP for tests/scans rather than have them at the their trust. If you have treatment, you are prescribed medication that doesn't cover the course required for recovery. The NHS is paying, but trusts are getting the kudos for staying within budget, whilst our GPs are doing unnecessary work that could have been arranged in clinic. Now that would save a few shillings and maybe some sick patients would get a GP appointment when they need it.

  • Re "General practitioners have been put in control of their budgets and they do what they can to spend as little money as possible."
    This concerns me a lot.

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