Most PMI policies only cover treatment by accepted drugs. Some will look at each on their merits. Some will only cover NICE approved drugs. Some have a total exception on experimental drugs. So which category will the new NICE bypassed drugs come under?
The British government will allow certain innovative drugs to bypass its healthcare cost-effectiveness watchdog. Currently, the National Institute for Health and Clinical Excellence (NICE) has to rule that drugs are good value before they can be reimbursed by the state-run National Health Service.
But a plan put forward by science and health ministers Paul Drayson and Ara Darzi, under the banner of the UK's Office for Life Sciences, will allow some innovative new drugs to be used for a period of time without that level of scrutiny.
NICE will select the drugs that are to be eligible under a three-year fast-track access scheme, which has been allocated a budget of 25 million pounds for the year 2010/11.
The new Innovation Pass scheme was warmly welcomed by drugmakers and biotech companies, who have previously complained that NICE often acts as a roadblock to new drugs by delaying access to novel treatments for serious conditions like cancer.
Drayson says getting new drugs used early was important not only for patients but also for research into the next generation of treatments, “Unless we have the means by which the most innovative breakthrough medicines can be put into clinical practice then we miss the opportunity for those breakthrough medicines to present the gold standard for clinical trials for new medicines which are coming through in those areas."
What NICE has become in practice is a rationing board. In March, NICE ruled against the use of two drugs, Lapatinib and Sutent that prolong the life of those with certain forms of breast and stomach cancer. This followed on a 2008 ruling against drugs that would help terminally ill kidney-cancer patients. In 2007, the board restricted access to two drugs for macular degeneration, a cause of blindness. NICE has limited the use of Alzheimer's drugs, including Aricept, for patients in the early stages of the disease. Doctors in the United Kingdom argued vociferously that the most effective way to slow the progress of the disease is to give drugs at the first sign of dementia. NICE ruled the drugs were not "cost effective" in early stages.