NHS England now plays a key gatekeeper role for the industry’s high cost specialised medicines, and has become increasingly commercially savvy over recent years, working alongside the National Institute of Clinical Excellence (NICE).
Late last year, NHS England went one step further to enhance its pricing and reimbursement expertise and appointed Blake Dark, an experienced Sanofi executive, as the new head of its commercial medicines division.
Dark has been transparent about his background and intentions since coming to the role being appointed executive set out his stall, saying that he had spent “24 years in the industry and nearly four months in the NHS, so still a little biased maybe, but let’s see”.
Dark's arrival coincided with the signing of a new five-year Voluntary Price and Access Scheme (VPAS), which caps NHS expenditure on medicines, but also allows NHS England to agree individual price and access deals with the industry. This has resulted in both successes and major disagreements. Although still in draft form, he has made it clear that it wouldn’t undermine or provide a way to bypass NICE, and neither would it compromise the principles of the VPAS deal.
Conversely, Dark has said the use of horizon scanning would be enhanced by NHS England, including understanding the entry of biosimilars and competitor products, while simultaneously providing new opportunities for strategic partnerships and bespoke access deals.
One of Blake Dark’s key messages to the sector so far has been that it should try to meet NICE’s cost effectiveness threshold of £30,000 per QALY at the first time of asking, rather than going above this level with the hope of negotiating a higher price. There is no doubt that NHS England will continue to drive a hard bargain, in light of costs for hospital-based drugs forecast to increase by value at a rate of 12% CAGR over the next five years.