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19 September 2016

Navigating uncertainty: pharmaceutical reimbursement in the UK

Written by: Shaun Beedle, Account Manager at Edelman

Health

NICE, SMC, CDF and EAMS* are, to many people, just nonsensical words on a page, but to pharmaceutical companies, each of these acronyms is a key to the gates of reimbursement. If you think the acronyms are hard enough to get your head around, the changes made to the reimbursement system earlier this year have left many with a handful of keys, unsure of which gates they open. Cue communications marketing – the approach that will help our clients navigate this uncertainty.

According to research by the Health and Social Care Information Centre (HSCIC), NHS England spent £15.5 billion on pharmaceuticals in 2015. The holder of those purse strings is the National Institute for Health and Care Excellence (NICE).

NICE, still the holy grail of reimbursement, evaluates and approves for use a treatment based on its cost-effectiveness. Once a drug gets the green light from NICE, it must be made available throughout the NHS. The Cancer Drugs Fund (CDF) is a stand-alone body created in 2010 to provide patients with access to cancer treatments that, while still in development, show promising efficacy. For terminally ill patients, the CDF provided them with a life-line. The gates were opened wide, however rapidly started to creak. The pot of money quickly spiralled out of control and so the gates were suddenly closed.

With patients, doctors and the private-sector all shut outside, the system was put under reform in a hope to allow access to the very best medicine for patients in the UK.

While this reform is still ongoing, we are starting to see some change. The CDF has been moved under NICE’s remit and treatments can now be directly referred to the fund. With the new system just launched in July 2016, confusion reigns.

The media is becoming increasingly focused on patients who are being denied access to medicines. This was observed in the recent debate around the funding of Pre-exposure prophylaxis (PrEP), as a preventative treatment for HIV. It is, therefore more important than ever that pharmaceutical companies act as educators – and tell stories that demonstrate the value of science. It is not enough to stand back and let the media showcase sometimes one-sided opinions that lack understandings of the complexities facing our clients.

A one-dimensional focus requires a multi-dimensional approach. We can no longer rely on traditional communications tools such as press releases and media relations to build a story. We need to equip our clients with the framework to build an integrated marketing approach using social, print and experiential channels. We need to provide a holistic strategy that demonstrates the value of innovation and educates the healthcare community, whether that be health care professionals, regulatory bodies, patient groups, policy makers or health media.

The reformed system is still in its infancy; and so only time will tell whether it’s a success. Rather than standing on the side lines we are busy equipping our clients with tools that will help them tell a holistic story to navigate these uncertainties and open the gates to patients.

*National Institute for Health and Care Excellence (NICE), Scottish Medicines Consortium (SMC), Cancer Drugs Fund (CDF) and Early Access to Medicines Scheme (EAMS).

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