Sarah Boseley, health editor
November 14, 2006
The White House is lobbying British ministers to allow the world's main drug companies unrestricted access to the NHS as part of a package of free market reforms for the service. The US government is positioning itself behind the giant pharmaceutical firms, predominantly based in America, which have been piling pressure on the body that approves drugs for use in hospitals and for prescription by GPs.
The drug companies claim that they are being held back by the National Institute for Clinical Excellence and have separately lobbied for it to be reformed.
In a surprising intervention, the US deputy health secretary, Alex Azar, forced the issue in London yesterday, ahead of talks with officials following a trip to the US last week by the health secretary, Patricia Hewitt. He said attempts to use rationing mechanisms such as Nice to cut soaring drugs bills would stifle innovation - an argument that is constantly made by the pharmaceutical industry.
Allowing all new drugs to be used in the NHS would result in the companies "fighting it out" on price, Mr Azar said, which would drive the drug bill down.
He made it clear that he was also in favour of the drug companies being allowed to advertise directly to patients. At the moment they may only advertise to doctors.
He also wanted to share the US experience of offering private insurance packages to people on Medicare - the healthcare scheme provided by the government to the poor and elderly. It might be possible for the UK government to consider something similar, he suggested, so that everyone could choose either a basic healthcare deal or top it up themselves if they wanted to pay for more than the state could afford.
Speaking to the Guardian, Mr Azar said healthcare systems in all wealthy countries were expensive, and costs were increasing at a time when budget constraints were getting more real as the population aged. "On the other side we have to focus on long-term innovation," he said. "How are we making sure that we don't take steps on cost containment that are short-sighted and prevent the investment in long-term biomedical research and development and innovation, so that when my kids are senior citizens we have the next generation and next, next, next generation of drugs?"
The White House arguments will increase the mounting pressure on Nice, which is regularly castigated by patient groups and drug companies when it rejects a new medicine from use in the NHS on cost grounds.
Recently there was an outcry over its ruling that new drugs for Alzheimers should be given only to those with moderate disease, and yesterday cancer charities objected to its preliminary ruling that a new drug, Tarceva, for lung cancer, should not be used in the NHS. Ministers have been directly lobbied by drug companies arguing that its decisions are ill-founded and inappropriate.
Yesterday Mr Azar emphasised the close contact his office has with the Department of Health and with European ministries. The links had been particularly useful in dealing with pandemic influenza preparedness, he said.
He said he had "some great discussions" with Ms Hewitt in the US last week and had followed them up with her officials and the Treasury.
"In all of our systems it is so easy to make the decision to cut costs today by going after drug prices, and to not focus on what will be the impact on long-term innovation," he said.
"I try to remember to advise people first off that we will never balance our budget going after drug prices. They are a relatively small proportion of the entire healthcare budget in our system."
Drugs and devices could keep people out of hospital and allow them to be cared for in their own homes, so saving costs, he said.