Half a billion here, half a billion there

doi:10.1136/bmj.c3072

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Tony Delamothe, deputy editor, BMJ

tdelamothe{at}bmj.com

To improve access for patients to costly medicines the Department of Health is looking at joint payment schemes with drug companies (doi:10.1136/bmj.c2832). This week we publish an object lesson in how not to run one.

As James Raftery explains, the UK’s first risk sharing scheme began in 2002 as a ruse to get round NICE’s ruling against use of interferon beta and glatiramer acetate in multiple sclerosis (doi:10.1136/bmj.c1672). The NHS would pay for the drugs, but cost effectiveness would be closely monitored, with an agreement to reduce prices if patients’ outcomes were worse than predicted. However, although outcomes were much worse than predicted (BMJ 2009;339:b4677, doi:10.1136/bmj.b4677), the prices haven’t come down.

The …