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NHS and Vertex remain deadlocked over price of cystic fibrosis drug

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1094 (Published 08 March 2019) Cite this as: BMJ 2019;364:l1094

Re: NHS and Vertex remain deadlocked over price of cystic fibrosis drug

Sir

In describing the latest episode in the Vertex saga Jacqui Wise covers the Health and Social Care Committee’s assessment of the various arguments (1).

She highlights that “both sides of the stalled negotiations on the provision of the cystic fibrosis drug Orkambi accused the other of inflexibility”. Vertex Pharmaceuticals “criticised NICE’s cost effectiveness assessments, saying that the system was 25 years old and not fit for purpose”. On the other side John Stewart, NHS England’s National Director of Specialised Commissioning responded with “all the company was interested in was trying to change the NICE process and had made absolutely no movement on price”.

She notes that Vertex representatives were to meet Matt Hancock the Secretary of State (SOS) on the 11th March. On the 8th March Sarah Wollaston Chair of the Committee wrote to the SOS (2). In her letter she said that the “Committee recognises that NICE is an internationally respected body which has provided a model for similar appraisal bodies around the world. Vertex needs to be able to provide evidence of the efficacy and value of its therapies on the same basis as expected of any other company and the Committee is concerned that it has stopped engaging with NICE. Furthermore, the NHS should not be expected to face costs for these drugs that simply cannot be justified by their cost benefit. In the context of finite resources, to do so would be to deny other NHS patients the benefit of effective therapies.”

The letter concludes with “We invite you to urge Vertex, at your meeting on Monday, to accept the necessity of demonstrating the worth of its therapies in accordance with the internationally-respected processes run by NICE; but in return, to assure Vertex that you will encourage NHS England and NICE to ensure that it is able to do so with high quality data which fully capture the evidence. If successful—and if Vertex cooperates with NICE in the collection of high-quality evidence—this can facilitate a flexible funding arrangement over time whereby NHS payments to Vertex reflect the evidence of clinical benefit in NHS patients.” In essence this is describing the methodology of the new cancer drugs fund after NICE took over because of its financial unsustainability (3). While it appears a potential and “flexible” way out it is unlikely to provide a lasting solution to the fundamental problem of excessive and unaffordable costs of many new drugs and does not address the issue that the pharmaceutical Industry should not be able to hold the NHS to ransom.

Rather than talking about flexibility and fudging the real arguments the letter’s final suggestion may prove more persuasive – “In the longer term, if Vertex cannot be persuaded to re-engage meaningfully in NICE processes, we suggest that you might want to explore the possibility of referring the company to the Competition and Markets Authority for what appears to us to be the exploitation of a monopoly position in the supply of drugs for the treatment of cystic fibrosis”.

References

1. NHS and vertex deadlocked over precise of cystic fibrosis drug. Wise J. BMJ 2019;364:1094
2. https://www.parliament.uk/business/committees/committees-a-z/commons-sel...
3. Challenges for the new Cancer Drugs Fund. Littlejohns P, Weale A, Kieslich K, Wilson J, Rumbold B, Max C, Rid A.. Lancet Oncol. 2016 Mar 3. pii: S1470-2045(16)00100-5.

Competing interests: No competing interests

18 March 2019
Peter Littlejohns
Professor of Public Health
Faculty of Life Sciences and Medicine, King's College London
Guys Campus