Drug giants threaten NHS over cheaper drug

Two multinational drug companies are threatening legal action to prevent patients being offered a cheaper version of an effective drug against blindness which could save the NHS £84 million a year.

12 NHS clinical commissioning groups (CCGs) in the north-east of England say that saving money to buy a save and effective - but 10 times cheaper - version of the drug for wet macular degeneration is preferable to cutting costs in other ways.

The drug for the condition is Lucentis, known generically as ranibizumab. But over a decade ago, doctors discovered an anti-cancer drug, Avastin, delivers just as good results, and when it is split into the tiny doses needed to inject into the back of the eye, it is a fraction of the price.

Genentech, the manufacturer of Avastin, refused to apply for a license for it to be used in eyes. But in 2012, the IVAN trial, funded by the NHS, showed that the two drugs were equally safe and effective, and that its use could save the NHS over £84 million a year.

The two drug giants that market Lucentis, Novartis and Bayer have warned NHS commissioners that they will seek a judicial review if they go ahead with their plans to offer Avastin.

David Hambleton, chief officer of the South Tyneside Clinical Commissioning Group, said: “Lots of the decisions and choices we are potentially facing are much less palatable than this one. This seems to most people to be an absolute no-brainer.”

Explaining in the British Medical Journal, he writes: “Every patient who chooses the cheaper alternative drug will help the NHS to fund important medical treatment in other areas. We want to have informed conversations with our patients so that they understand the wider effects of the choices we collectively make.”

NHS Clinical Commissioners said: “Where cheaper medicines that are equally clinically effective as a more expensive alternative are available, we call on the Department of Health to ensure that every possible avenue is explored to enable these savings to be realised. The time to take action on the use of this drug at a national level, to release cost-savings to use in other priority areas, is now.”

Bayer said Bayer said that splitting doses of Avastin into tiny injectable amounts created a different and unlicensed medicine. It said: “The principle of using unlicensed medicines when licensed and Nice-approved options are available runs the risk of setting a precedent that undermines the regulatory framework and NHS constitution. Bayer is currently considering its position including the possibility of legal proceedings against the CCGs who have implemented the policy.”

Novartis added that the new policy is ‘not in line with the current UK and EU legal and regulatory framework, the purpose of which is, among others, to protect patients and monitor the safe, appropriate use of medicines. The framework provides that unlicensed medicines can only be used where there is an unmet medical need. That is not the case here as there are two licensed products available in the UK, both of which have been approved by Nice as clinically and cost effective’.