The future role of NICE

In recent days there has been considerable media attention on the future funding of drugs and apparent plans to strip the National Institute for Health and Clinical Excellence of its power to make decisions on rationing. The relationship between doctors and drug companies has always been fraught.1 Debate about access to drugs in the NHS also inevitably causes a furious commotion as the competing interests of industry, prescribing doctors, and patient groups interact. Since the creation of the NHS, there has been conflict over prices and profits in the drug industry, along with debates about appropriate restrictions on doctors’ prescribing decisions and how to restrict patients’ demands for drugs.

For nearly 50 years, various forms of the Pharmaceutical Price Regulation Scheme (PPRS) have offered companies around a 20% target rate of return and freedom to set their own prices for new drugs. This relative generosity represents a compromise between health policy and “wealth policy”—the desire of successive governments to protect not only NHS budgets but also the important contribution of the drug industry to employment …