NHS Drug Pricing Disputes Leave Patients Facing Limited Treatment Options
London, UK – A growing controversy surrounding National Health Service (NHS) drug pricing negotiations is raising concerns that patients are being denied access to perhaps life-extending cancer treatments due to cost disagreements with pharmaceutical companies. Several innovative drugs, demonstrating significant clinical benefits, remain unavailable on the NHS in England, while being accessible elsewhere.
The dispute centres on the NHS’s cost-effectiveness assessments, conducted by the National Institute for Health and Care Excellence (Nice), which determine whether a drug’s price justifies its clinical benefit. Pharmaceutical companies are increasingly claiming these assessments undervalue innovative treatments, leading them to withdraw applications or refuse to submit them for approval.
Enhertu, an advanced antibody drug for “HER2-low metastatic breast cancer” – where the disease has spread and cancer cells exhibit a small amount of the HER2 protein – has shown remarkable results in trials. Patients on Enhertu lived twice as long without tumour progression and were one-third less likely to die over an 18-month period compared to those receiving standard chemotherapy. Despite this, talks between Nice and manufacturers AstraZeneca (AZ) and Daiichi Sankyo broke down last year. AZ has publicly criticised Nice’s classification of breast cancer as a “moderately severe” disease,arguing this impacts the price they are willing to pay. Enhertu is available on the NHS in Scotland. In the US,the drug carries a list price of nearly $5,000 per 100mg vial,roughly $165,000 annually per patient,while the UK price was reported at £1,455 per vial.
Another drug caught in the crossfire is Trodelvy,which delivers chemotherapy directly into breast cancer cells. Trials showed patients with “HR-positive HER2-negative” cancer, who had tired other treatment options, lived approximately 3-3.5 months longer on average with Trodelvy compared to standard chemotherapy. It also demonstrated a higher tumour shrinkage rate – 21% of patients treated with Trodelvy saw their tumours shrink, versus 14% with chemotherapy. Though, Gilead Sciences, the drug’s manufacturer, announced last month it would not submit Trodelvy for approval for the most common form of the disease, stating the required price discount would render a profit “inappropriate.” Approximately 500 women in England coudl benefit from the drug if approved for this use. Trodelvy is currently available on the NHS only for triple-negative breast cancer, a less common type. A private course of treatment for a 65kg patient costs roughly £45,000 for five-and-a-half months in the UK.
The issue extends beyond breast cancer. Reblozyl, used to treat anaemia in adults with beta-thalassemia and myelodysplastic syndromes (MDS) by stimulating red blood cell production, is also unavailable on the NHS in England. Manufacturer Bristol Myers Squibb opted not to submit evidence for review, preventing Nice from making a proposal. in the US, the annual cost for a 76kg patient ranges from $152,188 to $228,281, depending on dosage.
These cases highlight a growing tension between the NHS’s commitment to affordable healthcare and the rising cost of innovative pharmaceuticals, raising serious questions about access to potentially life-saving treatments for patients in England.The situation is prompting calls for a re-evaluation of the drug pricing process and a more collaborative approach between the NHS and pharmaceutical companies.
