Central fund 'is only way to end drugs rationing'

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Millions of pounds must be set aside in a central fund to pay for expensive new medicines to avoid "post-code prescribing", leading doctors said yesterday.

The Royal College of Physicians said that the only way to stop patients in some health authorities being denied effective treatment, while those in neighbouring areas get advanced medicines, is for costly drugs to be funded by the Government for the first couple of years, as was done in the 1980s for HIV medicines.

The NHS spends £6.3bn, 13 per cent of its annual budget, on medicines, the single largest expenditure after labour, and the cost is steadily rising. Between 1988 and 1998, the average cost of a prescription drug almost doubled from £4.87 to £9.16.

Health trusts have made different decisions about providing expensive new medicines for previously untreatable conditions, leading to widespread disappointment overpost-code prescribing and controversial rationing decisions.

InThe Prescribing of Costly Medicines, a report published yesterday, the college said that the public could no longer expect the NHS to pay for every new drug and that it was time to openly prioritise treatment.

"We have an enormous problem in how to fund new medicines and health technologies," said Dr John Mucklow, a consultant clinical pharmacologist at North Staffordshire Hospital and one of the report's authors. "The difficulties cannot be solved by throwing more money at the health service. We cannot afford everything we may want to have."

The college said that the NHS should not buy expensive medicines until their clinical- and cost-effectiveness had been evaluated by the National Institute for Clinical Excellence. Doctors also recommended that drug companies be asked to voluntarily agree not to promote drugs until the institute had approved them.

Many drugs - such as taxanes for the treatment of ovarian and breast cancer, beta interferon for multiple sclerosis, Riluzole for motor neurone disease and Ritalin for hyperactivity in children - have been used for years but have yet to be approved by the institute. The college recommends that health authorities be left to decide whether to fund them until they have been assessed.

Dr Mucklow said that drugs that were not approved by the institute should be unavailable except on private prescription. "Once priorities have been set, doctors treating patients will have to learn to live within the constraints," he said.

Professor Peter Baylis, the chairman of the working party which produced the report, said that doctors will have to inform patients that they could get the drug privately if they chose by going to a private doctor.