Prime Minister intervenes on future of Cancer Drugs Fund

The future of the England's Cancer Drugs Fund (CDF) is to be decided by the Prime Minister David Cameron, pharmaphorum has learnt.

Sources close to the decision-making have confirmed to pharmaphorum that the fate of the CDF, now costing £340 million a year, will be decided by Downing Street, and not by the Department of Health or NHS England.

Mr Cameron is understood to have demanded final say on the CDF because cancer treatment – and the rows over access to expensive new drugs – is such a highly charged issue with voters.

Number 10's intervention comes against a background of an escalating row between health secretary Jeremy Hunt and doctors and other healthcare professionals.

Hunt's confrontational handling of negotiations with NHS leaders on introducing seven-day working in the NHS and a new junior doctors' contract has generated huge animosity, with junior doctors in England now considering strike action.

David Cameron has now stepped in to ensure no further damaging rows are inflicted on his government.

One reason for this is clear: Cameron played a key role in setting up the Fund in 2010, which had been a Conservative manifesto pledge in the general election in May of that year. Conceived as a temporary – and very political – solution to bypassing the frequent and hugely unpopular 'no' decisions on cancer drugs from cost effectiveness watchdog NICE, the CDF is still in operation, and looks likely to remain, in one guise or another.

Mr Cameron's intervention has disrupted plans for a new, revamped CDF to be launched in April 2016, and has thrown a spanner in the works of an ongoing review of the entire medicines access system.

NHS England was forced to confront the CDF's overspend in late 2014, after the list of drugs given funding continued to grow, and the Fund's overspend ballooned, set against a growing NHS funding crisis.

This has led to two rounds of 'de-listings' of drugs from the Fund, undermining the political raison d'etre of the CDF.

Budget holder NHS England announced a proposal for a 'sustainable' system in July, turning the CDF into a managed access fund linked to NICE.

However the public consultation on the plans has never emerged, with Number 10 intervening before this could happen.

News of the delay has reached stakeholders, including charities and pharma companies, but the reason behind it has not been made public until now. Pharma industry association the ABPI last week said it was disappointed with the hold up, saying the future of the CDF was of "utmost importance to both patients and the industry".

Alison Clough, acting chief executive of the ABPI, said: "The backlog of medicines which are inaccessible to patients will continue to build unless the consultation is urgently progressed and new arrangements are in place from April 2016. The situation also causes huge uncertainty for the UK research environment. We would urge the government to end this delay and publish its consultation on proposals for the CDF."

The CDF's chairman Professor Peter Clark has made his feelings clear on the future of the Fund, calling on the government to introduce a more flexible system, allowing greater risk sharing between pharma and the NHS on price and the clinical benefits of promising but unproven drugs.

Speaking last night as a guest of honour at the annual dinner of small-medium pharma trade organisation the Ethical Medicines Industry Group (EMIG), Prof Clark said the 'rigidity' of the UK's pricing system needed to end, and did no favours to the NHS, industry or patients.

Prof Clark said a sustainable solution was needed, as new cancer drugs covering at least 40 indications were expected to be launched in the UK over the next few years.

The Prime Minister's intervention comes as another government-sponsored initiative, the Accelerated Access Review (AAR) works to find an 'end-to-end' solution for new medicines, medical devices and digital innovation to be adopted by the NHS.

The AAR is also expected to produce its final recommendations in April 2016; some had inferred that the delay to the CDF consultation was caused by a determination to co-ordinate these different initiatives in a fragmented NHS.

"If only things were that joined up," the source wryly commented to pharmaphorum.

Leslie Galloway, chairman of EMIG wants to see the wholescale reform of the UK pricing and market access system. This would include the CDF being absorbed into a New Medicines Fund, which would help speed uptake of medicines for all conditions, not just cancer.