Paperwork for reimbursement prevents PCTs access to high-cost cancer drugs

Report shows cost-sharing money not getting through

The amount of paperwork that primary care trusts (PCTs) have to fill out in order to be reimbursed for cancer drugs is so great that they may be missing out on millions of pounds, a report suggests.

Steve Williamson, consultant pharmacist for cancer services at Northumbria Healthcare NHS Foundation Trust, and David Thomson, lead pharmacist at Yorkshire Cancer Network, have produced a report into the uptake of patient access schemes (PASs) for cancer medicines.

The schemes are designed to improve access to high-cost cancer drugs which might not otherwise be deemed as cost-effective therapies by the National Institute for Health and Clinical Excellence (NICE) - the body tasked with providing guidance on NHS funding for medicines.

The scientists collected data from 37 PCTs with responsibility for 756 patients entered in PASs.

They found that refunds for two of the most common PASs - those for kidney cancer and gastrointestinal stromal tumour drug sunitinib and multiple myeloma drug bortezomib - may not have been passed on to the relevant PCT in half of cases.

Nearly three-quarters (73 per cent) of respondents said they did not have the capacity to manage more PASs without providing additional resources.

The average time taken to process the relevant PAS for each patient varied widely between schemes - from 17.5 minutes for lung cancer drug erlotinib to 45 minutes for bowel cancer drug cetuximab.

Writing in the journal Clinical Pharmacist, the study authors said that there is a "strong argument" for funding staff to track and manage PASs in order to prevent missed claims - which must be submitted within 60 days - and reduce the risk to the NHS.

"PASs have gained widespread acceptance by the pharmaceutical industry, which suggests that risk-sharing plans may become a staple feature of the market in the future," they wrote.

"PASs will only be effective in delivering financial value to the NHS if they can be implemented and managed by the NHS."

The study authors concluded: "The purpose of PASs is to allow drug prices to reflect value to NHS patients more accurately and increase access to cost-effective innovative medicines. This research shows that the NHS may be failing to deliver this worthy purpose and, unless properly managed and supported, that it will bear the financial risk of the schemes."

A spokesman for the Department of Health told the BBC that it was working with pharmaceutical companies to make PASs as easy to implement as possible.

"We have - through the National Institute for Health and Clinical Excellence - now set up an expert advisory panel with strong NHS representation which is consulted when schemes are proposed and which provides advice to the department on their implementability.

"Primary care trusts and hospital trusts need to agree locally between them how any rebates paid by drug companies are dealt with."

Hilary Tovey, policy manager at Cancer Research UK, said: "Patient Access Schemes have an important role to play in ensuring the NHS is getting value for money from the drugs it buys. The good news is that several new cancer drugs are now available on the NHS that might not have been before. But, these schemes must work in practice so it's disappointing to hear that money saved on cancer drugs is not getting through to the front line, where it's needed most.

"With changes on the horizon both in how the NHS is organised and how drugs are priced according to their value, the Department of Health will need to work with the NHS to ensure the money is used to buy the best possible treatments for patients in the future."