This ‘Reflection and Reaction’ article discusses patient access schemes (PAS), developed by pharmaceutical companies as a way of reducing the cost of a drug to the NHS (also known as risk-share schemes).  These schemes are seen as a way of improving access to new medicines, by improving their cost-effectiveness and thereby enabling NICE approval.  The first such scheme endorsed by NICE was the Velcade response scheme (VRS), which was incorporated into the Technology Appraisal for bortezomib in multiple myeloma. 

The author notes that published evidence on the effect of PAS is scarce, and concern regarding their benefits has been raised by the House of Commons Select Committee on Health.  In response to this, the British Oncology Pharmacy Association (BOPA) carried out research to assess the effect of these schemes on frontline NHS staff, and to identify any current problems, what works well, and to gain general feedback on their success.

The research, involving 31 NHS hospital trusts, focused on four specific schemes:  erlotinib for lung cancer, sunitinib for renal-cell cancer or gastrointestinal stromal tumour, bortezomib for multiple myeloma, and cetuximab for advanced colorectal cancer.  It was noted overall that PAS appear not to be working properly, and that there is a lack of capacity to manage them.  Specific problems included the following:

• 73% of respondents reported they did not have capacity to manage PAS without funding staff to manage, coordinate, and track the schemes
• Refunds received by hospital provider trusts for the sunitinib and bortezomib schemes were not being passed on to the PCT in almost half of cases
• Communication between doctors and pharmacists was highlighted as a problem with the bortezomib scheme, where every missed claim due to inadequate communication would result in a loss of £12,000.
• There is a need for flexibility around time limits for processing claims. Ideally, at least 90 days should be allowed to process claims and reduce the financial risk.
• Response-based schemes pose challenges for tracking patients and ensuring claims are made to refund non-responders.

Although pharmaceutical industries make assumptions about the time burden for managing PAS, the reality may be very different.  73% of respondents would support the development of approved standard templates for PAS, to reduce their variability.  The author recommends that organisations consider investing in staff to implement and manage PAS.