Responsibility for the prescribing and supply of these medicines is retained by Surrey and Sussex Healthcare NHS Trust (SASH). In some instances where SASH is not commissioned to treat a specific clinical condition patient will be referred to the specialist hospital to access treatment or treatment can still be provided by SASH under a shared care agreement with the specialist centre.

A number of high-cost drugs, devices, procedures and products have been excluded from the scope of the national tariff of payment by results. ‘high cost drugs’ are typically for specialist use and the commissioning arrangements for these drugs are to ensure their safe, effective and appropriate use within available funding. These drugs are commissioned by:

  • NHS England or
  • Clinical commissioning groups (CCGs)

Here is a comprehensive list of medicines not reimbursed through the national prices and directly commissioned by NHS England is available.

A summary of PbR excluded from tariff drugs commissioned by CCG or NHSE is available here (2020-21).

 

There are many complex drugs and devices used in medicine that require specialist input to maintain safe patient care. These medicines and devices are often very expensive and therefore classed as ‘high-cost Drugs’. They are excluded from the National Tariff of Payment by Results (PbR) and require commissioner approval.

If an individual falls outside of the range of services and treatments routinely commissioned by NHSE, ICB or CDF or when there is evidence of clinical exceptionality and Individual Funding Request (IFR) will need to be submitted by the clinician to the relevant commissioner to seek approval for that treatment.

NHS England are the responsible commissioners for the Cancer Drugs Fund (CDF).  The CDF is a source of funding for cancer drugs in England To see which treatments are currently funded by the CDF, please see the Cancer Drugs Fund List.

Patient Access Schemes are pricing agreements proposed by pharmaceutical companies to enable patients to gain access to high cost drugs that are not likely to be approved by NICE for use in the NHS because they are expensive and do not have a significant benefit over existing treatments. click here for a list of technologies with approved Patient Access Schemes .

These medicines and devices are commissioned by:

· NHS England (NHSE)

· Cancer Drug Fund (CDF)

· Integrated Care Boards (ICBs)

Additionally, commissioner requirements dictate that these medicines and devices are used and only paid for where they are used within the approved NICE Guidelines and Technology Appraisals.

Policy

In the ever-evolving landscape of healthcare, the utilisation of biological medicines has become integral to the treatment of various chronic and severe conditions, such as rheumatoid arthritis, diabetes, and certain forms of cancer.

 

As patents for these biological medicines expire, biosimilars – which are highly similar, but not identical, to the originator product – enter the market, offering a more cost-effective alternative while maintaining similar efficacy and safety profiles. There may be instances where the originator product offers better value to the NHS, for example, if the price were to reduce in response to market competition.

 

SASH is committed to procurement and utilising of the best value of biologicals and biosimilars in instances where brand patents have expired and generic/biosimilar alternatives are available. SASH will be adopting a switching strategy to the most cost-effective option as outlined in the Surrey Heartlands-wide Policy on the use of Biological & Biosimilar of Best Value. This is to ensure system-wide commitment to achieve NHS England's aspirations to prescribe the most cost-effective treatment to achieve substantial savings and therefore use this money to support patient care in other ways.

Pharmacy contact details

Miria Steter

Shelley Murphy

Jemma Hive