On 20 June, MSPs debated access to medicines in Scotland, after a motion (S5M-12856) was brought by Anas Sarwar MSP, calling on the Scottish government to deliver access to Perjeta, a treatment for breast cancer, and Orkambi, a treatment for cystic fibrosis, and to improve ways of negotiating with drug companies on the cost of medicines. The MSPs made emotive speeches drawing on the experience of constituents suffering from the diseases, whilst also making broader points on the weaknesses of the current system for providing patient access to medicines.
Anas Sarwar, in his opening speech, pointed out that whilst Perjeta was available in England on the NHS, it had been designated as not cost effective in Scotland. He also criticised the bureaucratic delay in approving Orkambi, and called for the recommendation in the Montgomery review, the ability to negotiate on price during the approval process, to be implemented immediately. Finally, he called for additional funds for health boards so that they could approve access to medicines without diverting funds away from existing services.
In her reply, Shona Robison MSP, the Scottish Secretary for Health and Sport, highlighted the fact that the Scottish Medicines Consortium now approves 79 per cent of submissions, up from 48 per cent between 2011 and 2013. She also repeated her announcement that from October, ultra-orphan medicines would be available on the NHS for at least three years while information on their cost effectiveness was gathered, and said she had instructed the Scottish Government’s chief pharmaceutical officer to write to the SMC to determine whether Orkambi might be considered in this way.
Robison stated that under the new peer-approved clinical system, PACS tier 2, the cost of a medicine was no longer a factor when a clinician’s request for individual access was being considered. Finally, she described how a new voluntary system to ensure that discounts offered to one part of the UK are made available at the same level in Scotland would help prevent medicines available in England from being unavailable in Scotland.
Miles Briggs, a Conservative MSP for Lothian, went on to echo many of Anas Sarwar’s points, whilst moving for a further amendment to reform the Patient Access Scheme Assessment Group, in order to make access to new drugs easier. Alison Johnstone Green, a Green MSP for Lothian, criticised the pharmaceutical industry’s failure to offer fair prices, and pointed out that, when improving the cost effectiveness of drugs, whilst the clinical effects of individual drugs couldn’t be changed, the price offered by pharmaceutical companies was variable.
Willie Rennie, the Liberal Democrat MSP for North East Fife, reminded Shona Robison that Perjeta would not be covered by the new ultra-orphan pathway, and patients would have to rely individually on the new PACS tier 2 process. He questioned why, even though the current PPRS system restrains Scotland’s ability to negotiate with companies, Wales and Northern Ireland were both still able to approve Perjeta alongside England.
Shona Robison, in her closing remarks, stated that she was unable to answer Willie Rennie’s questions about the deal struck by NHS England over Perjeta, as she was prevented from revealing details about the discount by commercial confidentiality. She also responded to a number of points made by MSPs in favour of a portfolio approach, arguing that as it involved unlicensed medicines, it bypassed the health technology assessment process and therefore it eased tests on clinical effectiveness.