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Administrative issues plague patient access schemes in Britain
Results show providers lack ability, personnel to efficiently manage plans.
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The National Health Service in the United Kingdom has accepted patient access schemes created by pharmaceutical companies to ensure that patients would have access to anticancer drugs deemed too expensive or not cost-effective by the National Institute for Clinical Excellence, or NICE. However, results from a recent survey showed that providers did not have the staff to manage the schemes, and in many cases, providers were not properly reimbursed for administering expensive medications.
In the United Kingdom, NICE determines whether NHS will pay for a treatment. Patients receive their medications in hospital provider trusts, which are then reimbursed by the patient’s local primary care trust.
The British Oncology Pharmacy Association surveyed 31 NHS hospital trusts, which treated 756 patients entered into a patient access schemes that operated for at least 12 months from 2007 to 2009. The association looked into schemes for erlotinib (Tarceva, OSI) for lung cancer, sunitinib (Sutent, Pfizer) for renal cell cancer or gastrointestinal stromal tumor, bortezomib (Velcade, Millennium) for multiple myeloma and cetuximab (Erbitux, Imclone) for advanced colorectal cancers.
In 47% of cases involving sunitinib and bortezomib, two of the most common schemes, refunds received by hospital provider trusts were not passed on to the patients’ local primary care trust. Reviewing the results in the Lancet Oncology, Steve Williamson, consultant pharmacist in cancer services at Northumbria Healthcare NHS Trust Pharmacy, said the end result is that purchasers were paying full price for discounted drugs. The NHS said it fears that the purchasing primary care trusts will not accept patient access schemes if they do not receive that refund.
Additionally, 73% of respondents said they could not manage patient access schemes without paying staff to coordinate, manage and track the schemes. Williamson said such difficulties could prevent future schemes from being implemented. There was no consensus over which of the schemes was best or worse.
Communication between doctors managing treatment and pharmacists managing the scheme was the key to success. The researchers found that with bortezomib, every claim that was missed due to inadequate communication resulted in a loss of £12,000.
“There seems to be much frustration with [patient access schemes] and a desire to see improvements to the way the NHS supports the implementation of these schemes,” Williamson wrote. “The formation by NICE of a dedicated body, the Patient Access Scheme Liaison Unit, to coordinate these schemes is seen as a positive step.”
The researchers found that 90 days should be allowed to process claims and reduce the financial risk, and 73% of respondents thought a set nationally approved standard templates for the schemes allowing manufacturers to select a familiar off-the-shelf scheme would be beneficial.
For more information:
- Williamson S. Lancet Oncology. 2010;doi:10.1016/S1470-2045(09)70402-4.