Representing KCSN, Sharon Kell went along to the Cancer52 All Members Meeting on 23rd January to hear presentations from Dr Paul Catchpole, Value and Access Director at the Association of British Pharmaceutical Industry (ABPI), and David Fitzgerald, National Cancer Programme Director at NHS England.
Paul gave an explanation of the new Voluntary Pricing and Access Scheme (VPAS), which is an agreement between the Department of Health and the ABPI on getting the best value and most effective medicines into use by the NHS more quickly. The scheme replaces the old Pharmaceutical Price Regulation Scheme (PPRS), and sets the prices of branded medicines (not generic medicines) paid by the NHS. The new VPAS came into effect this month (January 2019).
Pharmaceutical companies can choose whether to join the scheme, and 172 companies have joined representing 87% of branded medicines. The new scheme represents a commitment by government to help get medicines to patients quicker.
Key aspects of VPAS include:
  • The pharmaceutical payment mechanism allows 2% growth of the NHS medicines bill – anything over that is paid back by the pharmaceutical industry
  • First £5m of sales of a new drug are excluded from the pay back and pay back payments are tapered between £5-25m of sales
  • Small companies with less than £5m profit are excluded from the pay back
  • New medicines are excluded from the pay back for the first 36 months (back dated to January 2018)
  • Pharmaceutical companies still have the freedom to set their list price for new medicines.
With this scheme, there is concern that large pharmaceutical companies won’t attempt to develop medicines for rare and less common indications with small patient numbers because of the potential impact of the new ‘pay to appraise’ fee rendering these medicines unprofitable.
David gave an update about how the NHS England Long Term Plan is going to play out, with particular reference to rare and less common cancers.
In reference to cancer services, the aim of the Long Term Plan is an extra 55,000 people each year surviving cancer for at least 5 years following their diagnosis, and three in four cancers (75%) diagnosed at stage 1 or 2. These aims are for all types of cancer. In 2016, 57% of kidney cancers were diagnosed in stage 1 and 2 (Public Health England figures). The Long Term Plan focuses on prevention of cancer (smoking, alcohol consumption, obesity), screening for cancer, and fast access to diagnostic tests (rapid diagnostic centres and 28-day faster diagnosis standard).
Cancer treatment is becoming more personalised through the use of genomics, and new types of therapy are being introduced (CAR-T, proton beam, ungraded LINACs). Follow-up care is becoming more holistic with improved access to CNSs due to enhancement of the workforce through recruitment and training of nursing staff and the Cancer Workforce Plan. There is more collaboration with academia and industry and an improvement in real world testing of innovation through the Cancer Alliances and rapid diagnostic centres to accelerate access and uptake of new treatments.
The four priorities for NHS England are:
  1. Implementation planning to turn commitments into reality
  2. Governance and structures to support delivery of the Long Term Plan
  3. Continued reinforcement of the leadership in Cancer Alliances
  4. Ensuring that the national team is set-up for delivery of the Long Term Plan.

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