High-cost drug treatments

​​Request 722061221

1 Who decides if a high-cost drug is to be allowed to be prescribed to a patient?

2 What medical qualifications do these individuals hold?

3 What goes into the final decision on if they are permit-able?

4 Can additional medical treatment for the same condition be sought?

Response

The information included in this response pertains to prescribing through Health and Care Jersey (HCJ). 

Medicines on the ‘Prescribed List’ for General Practitioner prescribing are considered by the Pharmaceutical Benefit Advisory Committee (PBAC) and approved by the Minister for Social Security. Further information can be found in a Freedom of Information response published on www.gov.je at the following link:

gov.je/government/freedomofinformation/pages/foi.aspx?ReportID=6084​

1

Any medicine (including High-Cost Drugs) listed in the Jersey General Hospital formulary can be prescribed by a suitably competent prescriber to patients under their care. Clinicians can apply for medicines to be included in the formulary with the support of the Head of Service for the relevant Care Group. Applications are considered for approval at the Medicines Optimisation Committee. The Jersey General Hospital formulary is available online at Hospital pharmacy​.

Where the National Institute for Health and Clinical Excellence (NICE) has reviewed a medicine and determined that it represents a cost-effective use of (NHS England) resources for a particular indication, the Medicines Optimisation Committee generally adopts their opinion. Similarly, if a medicine is approved in the NHS England Cancer Drug List, this medicine is also generally adopted for use in Jersey, in line with any criteria specified in the Cancer Drug Fund list.

If a consultant assesses a patient as having a unique condition that falls outside of the terms of the NICE Technology Appraisal or the Cancer Drug Fund criteria, and no other patients are likely to have a similar condition, the consultant can submit an Individual Patient Funding Request (IPFR) for consideration by an IPFR panel. 

Where NICE have reviewed a medicine and issued guidance such that the medicine does not represent a cost-effective use of resources for a given indication, the Medicines Optimisation Committee will automatically adopt this guidance and will not consider any application in relation to the particular medicine and indication, unless significant new evidence or cost information becomes available.

2

The Medicines Optimisation Committee has medical, nurse and pharmacist representation. Medical consultants and senior medical and nursing officers attend, along with senior pharmacists.  An IPFR panel must have a minimum of three clinicians present, including two consultants and a senior pharmacist.  A Clinical Governance team member, who may also be a registered nurse or doctor, is a member of the Medicines Optimisation Committee and IPFR panel.

3

The Medicines Optimisation Committee and the IPFR panel considers the following when approving medicines:

• Intended use

• Evidence of efficacy:

• Clinical evidence

• Cost-effectiveness

• Financial implications.

The Head of Service (formerly the Associate Medical Director) for the relevant Care Group ensures funding is available to support the use of new medicines. If a medicine requires additional services that are not currently available (for example, genetic tests or attendance at a tertiary site off-island), approval to fund these additional costs is required from the HCJ Senior Leadership Team.

4

Yes, additional medical treatment for the same condition can be sought, provided that: 

• there is an appropriate medicine available on the hospital formulary;

• the clinician believes that the medicine will be effective for the patient and the patient consents to treatment.

If the medicine is not listed on the hospital formulary, a formulary application can be submitted, as outlined above.​