Covert is much worse than overt rationing: PrEP rationing is symptomatic of NHS bid to cut costs, at all costs

Chris Smyth on November 11th 2016 reports in The Times: Sick children to miss out after ruling on HIV drugs

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Children with cystic fibrosis are among patients caught in a stand-off between the NHS and a drug company over the cost of a daily pill to prevent HIV after the Court of Appeal ruled that health chiefs could not wriggle out of paying.

NHS England said that drug firms would be to blame if “excessively high pricing” meant that the health service could no longer afford nine treatments for cancer and other conditions because it had to pay for the HIV drug.

Aids campaigners said they were delighted after NHS England lost its appeal against a High Court ruling that it was responsible for funding pre- exposure prophylaxis (PrEP), which reduces the risk of infection in gay men by almost 90 per cent.

NHS bosses had argued that they had no legal requirement to pay for preventative treatments. The drug has become a flashpoint for NHS rationing after health chiefs issued a blunt warning that they would not able to pay for other specialised treatments after the HIV-drug ruling.

These include a drug costing £182,625 a year that improves breathing for some children with cystic fibrosis, as well as stem cell transplants for a form of blood cancer and a type of prosthetic knee for amputees.

NHS England is trying to shame Gilead Sciences, which makes the HIV drug, into dropping the cost of PrEP. It has a list price of £4,000 per patient and officials say the company has been unwilling to offer discounts.

Expert advisers are understood to have judged that PrEP scores highly for price effectiveness but NHS England says that at a cost of up to £20 million a year, many other treatments will have to be ditched. Deborah Gold, chief executive of the National Aids Trust, which brought the case against NHS England, said: “PrEP works, it saves money, and most importantly it has the power to prevent HIV acquisition for thousands of people.”

She said that the charity had been “putting pressure on everybody” to reach a deal to make PrEP available in sexual health clinics. “It’s incumbent on Gilead to come to the negotiating table and give a fair price,” she said.

NHS England said that it would ask the drug company to reconsider its pricing. It will also explore the options for using generics.

Gilead did not respond to requests for comment but Richard Torbett of the Association of the British Pharmaceutical Industry said the case showed that NHS England’s system for commissioning was unpredictable.

Ben Spencer and Ben Wilkinson report the same subject in the Mail

Kieth Alcom in namaidsmap reported 6th June in Australia: Australia shows an alternative to rationing hepatitis C treatment

Hundreds of people with rare diseases could miss out on vital treatments after the NHS was ordered to consider bankrolling a controversial HIV pill.

Toddlers with cystic fibrosis, deaf children and amputees may now be denied a range of new medical devices and breakthrough drugs.

NHS England has a budget of £25million a year for specialised new treatments and equipment for rare diseases.

But yesterday’s Court of Appeal ruling means up to £20million may be diverted to provide pills for those at risk of HIV infection due to their high-risk sex lives, including up to 5,000 gay men. Critics fear it will encourage ‘sexual risk-taking’.

Dennis Campbell in the Guardian 2nd August reports: PrEP rationing is symptomatic of NHS bid to cut costs, at all costs

A steady process of restricting care and medicine in order to save funds has put patients at risk and angered doctors

Comment from the Times:

Chris Huckle 5ptsStandardFeatured
2 days ago

Cystic fibrosis is a genetic disease so it could be argued that it is just as preventable if parents took the responsibility for proper testing before conceiving.Even more egregious are those parents knowing they are both carriers still gamble. Furthermore , at£182,000 per patient vs £4000 for PrEP ,46 people could be helped vs 1 with CF.

This is ridiculous; People can either practice safe sex or buy PrEP themselves. Children/adults with cystic fibrosis have limited options as they are born with a life limiting disease. Similarly, people with cancer have limit ed choices. It is invidious to make this choice. However, HIV is highly politicised, so the lobby gets what it wants. Remember, the NHS budget is finite. Why should the general public and other patients pay so that people can avoid using a condom? Sexual transmission of HIV is preventable by safe sex. Condom use is widely appropriate due to the risk of other STDs.