Intended for healthcare professionals

Feature Investigation

A pill too hard to swallow: how the NHS is limiting access to high priced drugs

BMJ 2016; 354 doi: (Published 27 July 2016) Cite this as: BMJ 2016;354:i4117
  1. Jonathan Gornall, freelance journalist1,
  2. Amanda Hoey, consultant,
  3. Piotr Ozieranski, lecturer3
  1. 1Suffolk, UK
  2. 2Department of Sociology, University of Cambridge, Cambridge, UK
  3. 3Department of Social and Policy Sciences, University of Bath, Bath, UK
  1. Correspondence to: A Hoey ah839{at}

A joint investigation by The BMJ and Cambridge and Bath universities uncovers how NHS England tried to limit access to expensive new drugs for hepatitis C. Jonathan Gornall, Amanda Hoey, and Piotr Ozieranski report

Highly priced medicines are challenging health systems around the world in unprecedented ways. And none more so than the new sofosbuvir based antiviral drugs introduced by Gilead Sciences in 2014. Offering greatly reduced treatment durations and high cure rates, these medicines hold out the real prospect of eliminating hepatitis C in countries where they are widely administered, with all that implies for long term savings in healthcare costs.

But launch of these drugs has ignited a global debate about high priced medicines. With launch prices ranging from around $90 000 (£69 000; €82 000) per patient in the US to almost £35 000 in England and €41 000 in France,1 they have sparked a US Senate investigation (box), been raised at both the G7 and G20 summits, and has been a major consideration for to a UN high level panel on access to medicines.

The hepatitis C medicines have intensified tensions between drug companies’ duty to put shareholders’ interests first and governments with limited health resources. Sofosbuvir is not the first high priced medicine. Many novel cancer medicines provide only marginal benefits but cost over $100 000 per patient a year. But because hepatitis C affects so many people it has become a pill too hard to swallow for budget planners. Rationing, in their view, became inevitable.

Now there is new evidence about the extent to which hepatitis C treatments have challenged one of the most developed systems for assessing the value of new therapies and delivering them to patients: the NHS and the National Institute for Health and Care Excellence (NICE) in England.

In a joint investigation, The …

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