Patient Access Scheme(s) Project

Patient Access Scheme(s) (PAS) are one way in which pharmaceutical companies can lower the acquisition cost of a medicine to the NHS, enabling patients to gain access to high cost medicine treatments.

They are sometimes referred to as risk share schemes or market access schemes. PAS have been available via NICE since 2002 and also more recently via the CDF. Although PAS unequivocally aim to improve access to new medicines for NHS patients, it is essential that the costs of operating them and the financial benefits actually realised locally are assessed as carefully as the clinical benefits of the medicines themselves to ensure that they offer the NHS genuine value for money. If PAS are not implemented the NHS may incur unnecessary costs. Implementation of NICE-approved PAS also ensures local compliance with NICE technology appraisal guidance.

PAS operate via two main mechanisms:

• "Price discount schemes" – the pharmaceutical company passes on a straightforward discount of X% on the price of the drug. This will be the price invoiced to the organisation and no new internal process/mechanisms require implementation.
• "Manual managed discount schemes" – an internal process/mechanism has to be implemented in order to allow the potential cost avoidance to be realised. This may be resource intensive and involve multiple departments within the organisation.

The PAS Project

LPP is continuing the PAS project initiated in 2013, which has now been expanded to encompass all non-cancer and cancer PAS, both NICE-approved and those in the CDF.

One of the main aims of the project is to ascertain if the PAS are being successfully implemented and if not, to assist with implementation. To do this, work has been undertaken to identify, map and track use of PAS in London, and to identify any barriers to implementation. Cost avoidance derived from the use of PAS is also calculated for each drug and organisation. It is important to note that since evidence so far shows that in London compliance with PAS is very high, provider financial plans will reflect PAS prices. The cost avoidance quantified by this monitoring exercise does not therefore represent new, cash-releasing savings opportunities for providers.

The initial data gathering exercises, for the manual or non-discount schemes, which enabled us to identify which schemes were being taken up by each trust across London was stopped after 2016/17 since it was very labour intensive and accounted for less than 10% of the overall cost avoidance.

The information received from previous data collection exercises indicates that there is a very high level of uptake, with a total cost avoidance of approximately £44 million in 2013/2014, the first year of this project, rising to just under £196 million in 2019/20 .

Reports to facilitate identification of apparent instances of variance from PAS discount pricing are sent to trusts on a quarterly basis.

Further information

A list of NICE-approved PAS is available on the NICE website: https://www.nice.org.uk/about/what-we-do/patient-access-schemes-liaison-unit/list-of-technologies-with-approved-patient-access-schemes

To sign up for the NICE-maintained Operational PAS Update e-mail list, send an e-mail to PASLUMail@nice.org.uk with 'Operational PAS Update' in the subject line.

Enquiries

For enquiries regarding availability of previous PAS reports, or for any other information please contact Pauline McCalla on pauline.mccalla@nhs.net.