Definition of High Cost Drugs
There are many complex drugs and devices used in medicine that require specialist input to maintain safe patient care. These medicines and devices are often very expensive and therefore classed as ‘High Cost Drugs’. They are excluded from the National Tariff of Payment by Results (PbR) and require commissioner approval.
Commissioning of High Cost Drugs
These medicines and devices are commissioned by:
• NHS England (NHSE)
• Cancer Drug Fund (CDF)
• Integrated Care Boards (ICBs)
Additionally, commissioner requirements dictate that these medicines and devices are used and only paid for where they are used within the approved NICE Guidelines and Technology Appraisals.
Responsibility for the prescribing and supply of these medicines is retained by Surrey and Sussex Healthcare NHS Trust (SASH). In some instances where SASH is not commissioned to treat a specific clinical condition patient will be referred to the specialist hospital to access treatment or treatment can still be provided by SASH under a shared care agreement with the specialist centre.
Individual Funding Request
If an individual fall outside of the range of services and treatments routinely commissioned by NHSE, ICB or CDF or when there is an evidence of clinical exceptionality and Individual Funding Request (IFR) will need to be submitted by the clinician to the relevant commissioner to seek approval for that treatment.
Use of biological and biosimilar medicines
In the ever-evolving landscape of healthcare, the utilisation of biological medicines has become integral to the treatment of various chronic and severe conditions, such as rheumatoid arthritis, diabetes, and certain forms of cancer.
As patents for these biological medicines expire, biosimilars – which are highly similar, but not identical, to the originator product – enter the market, offering a more cost-effective alternative while maintaining similar efficacy and safety profiles. There may be instances where the originator product offers better value to the NHS, for example if the price were to reduce in response to market competition.
SASH is committed to procurement and utilising of the best value of biologicals and biosimilars in instances where brand patents have expired and generic/biosimilar alternatives are available. SASH will be adopting a switching strategy to the most cost-effective option as outlined in the Surrey Heartlands wide Policy on use of Biological & Biosimilar of Best Value. This is to ensure system-wide commitment to achieve NHS England aspirations to prescribe most cost-effective treatment to achieve substantial savings and therefore use this money to support patient care in other ways.
Policy: download.cfm (surreyheartlands.org)