Amendment 10 is intended to insert into the Bill some of the criteria that I hope would form part of a value assessment for pricing of medicines. The difficulty is that, as things stand, the structure of the two schemes is not designed to take account of those criteria. It is not a value assessment but a budgetary control process. We are, to that extent, looking at an amendment the purpose of which is to put into the legislation criteria applicable to the design of a future PPRS.
I have in the past—in a debate in my name in another place, back in December 2014—expressed the view that we could redesign the existing PPRS to reflect the value of medicines. That would be done by modulating the extent of the rebate payable, such that medicines that were relatively costly in relation to their determined value under such a system would pay a higher proportion of the rebate than those that appeared, on the basis of this assessment, to be charged at something more relevant to the implied value. That is in the existing scheme and I see no prospect of it being revised during its present life through to the end of 2018. An amendment of this character would clearly be designed in relation to a future PPRS.
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I have two additional points. First, why would it relate to new chemical entities or new indications of a use for an existing medicine? That is to reflect the view—which was always made clear to me by the industry —that value as a basis for pricing control should be introduced progressively in relation to new medicines, rather than applied retrospectively to its existing pricing structure in order to provide a degree of stability for it, with a transition towards a full value-based pricing system. I completely understand that; I have written it into the amendment simply to reflect that thought.
Secondly, are these the right criteria? I will leave it to noble Lords to see whether they regard it as having the right character. We all know that we want to assess the therapeutic benefit. We have to try and meet the as yet unmet need. We want to take account of wider social benefit. It is possible to do it and NICE sometimes does it under its present formula for economic evaluation. However, the wider impact of something such as a highly effective medicine for the treatment of early-onset Alzheimer’s, for example, would have very substantial social benefits that cannot yet be fully incorporated into a NICE evaluation.
On the point about proposed subsection 2(d), we have to make it clear that we are asking Ministers to arrive at a position on a future PPRS where responsible clinicians taking account of relative benefit evaluations are able to make any licensed and effective medicine available to their patients. It should then be between government and the industry to pay the relevant appropriate price, but the outcome of the system should not be that patients do not have access to the medicines appropriate for them. We know that innovation and affordability for the NHS are existing criteria that should be incorporated into the structure of the PPRS. This amendment is a sighting shot for our discussion today. What should be taken into account by Ministers in making determinations about any design of a new PPRS and determining prices under that system? I beg to move.