National health services pharmaceuticals

In this book I will share with you the process by which I came to this conclusion and the scientific evidence on which it is based. This includes evidence that was known to the pharmaceutical companies and to regulatory agencies, but that was intentionally withheld from prescribing physicians, their patients and even from the National Institute for Health and Clinical Excellence (NICE) when it was drawing up treatment guidelines for the National Health Service (NHS) in the UK. 

Our empirical evaluation of competition between pharmaceuticals was based on information on prescription drug consumption by non-hospital patients in the National Health Service (NHS) in England in 19% and the Sistema Nacional de Salud or SNS (National Health System) in Spain in 1997. The authors wish to thank Statistics Division IE of the UK Department of Health and the Directorate-General of Pharmacy and Health Products of the Spanish Ministry of Health and Consumer Affairs for supplying us with these data. As can be seen from Table 4.1, public consumption of pharmaceuticals... 

Since 1990, responsibility for containing the public pharmaceutical bill in Spain has fallen to a variety of instruments, none of which has proved particularly effective at cost containment, as can be seen from Table 6.1. These instruments have included stricter control over the National Health Service (NHS) (Sistema Nacional de Salud or SNS) budget for pharmaceuticals, modifications to the co-payment rates for certain drugs for chronic diseases, the exclusion of certain drugs from public financing (negative lists) and agreements with laboratories and pharmacies.1... 

The ABPI is the trade association that represents the manufacturers of prescription medicines. Formed in 1930, it now represents some 80 companies, which produce over 80% of the medicines supplied to the National Health Service (NHS). The ABPI has had a code of practice since 1958, the Code of Practice for the Pharmaceutical Industry, which governs the promotion of medicines to health professionals, and has operated a system whereby complaints made about the advertising of prescription medicines are taken up and considered under the Code. It is a condition of membership of the ABPI to abide by the Code of Practice. In addition, some 70 companies that are not members of the ABPI have given their formal agreement to abide by the Code and to accept the jurisdiction of the PMCPA over complaints made under the Code. Thus, the Code... 

The Association of the British Pharmaceutical Industry (ABPI) is the trade association representing manufacturers of prescription medicines. It was formed in 1930 and now represents about eighty companies which supply nearly 80 per cent of the medicines used by the National Health Service. 

The ABPI examinations for medical representatives and generic sales representatives are based on a syllabus published by the ABPI which covers, as appropriate, subjects such as body systems, disease processes and pharmacology, the classification of medicines and pharmaceutical technology. Information on the National Health Service and pharmaceutical industry forms an additional core part of the syllabus. The syllabus is complementary to, and may be incorporated within, the company s induction training which is provided to representatives as a pre-requisite to carrying out their function. 

Generally, there is no contract between the pharmaceutical company and the patient who is prescribed the product by a doctor. In the United Kingdom, it has been held that where a product is prescribed under a National Health Service scheme, it is not prescribed as a result of a contract between the pharmaceutical company and the patient because legislation exists that requires a pharmacist to supply the product on the production of a valid prescription. For nonprescription, over-the-counter (OTC) products, there is a contract between the retailer and the consumer who purchases the pharmaceutical product, but there is still usually no direct link in contractual terms to the manufacturer of the product. It may be, however, that the contract between the manufacturer and the retailer contains an indemnity provision. Then, in the event of a successful claim for breach of contract made against the retailer by the customer, the manufacturer would effectively be required to reimburse the retailer for the amount ordered to be paid in compensation to the customer. 

The prices of medicines sold to the National Health Service are controlled in the UK by the Pharmaceutical Price Regulation Scheme (PPRS) , negotiated periodically every five to six years by the Department of Health (DoH) with the Association of the British Pharmaceutical Industry (ABPI), for example in 1979, 1986, 1993 and 1999. The PPRS controls the maximum - but not guaranteed — profits that pharmaceutical companies make on the capital they have invested in plant for research, development and manufacturing for sales made to the NHS. (Capital employed by the individual companies is allocated between that devoted to NHS sales and that for non-NHS sales and exports.)... 

In the United Kingdom, the government controls the cost of pharmaceuticals not by limiting individual product prices, but by setting a cap on the profit that individual pharmaceutical companies can enjoy from their business with the National Health Service. Each company negotiates with the Secretariat of Pharmaceutical Price Regulation Scheme (PPRS) a total rate of return on the capital employed in generating its sales to the British National Health Service (NHS). 

The current version of the PPRS policy expired in October 1992. In late October 1992, negotiations were underway between the National Health Service and the Association of the British Pharmaceutical Industry to reformulate and reauthorize the PPRS. It is expected that the PPRS will be reauthorized without any major structural changes (45). However, the future direction of the program is still unclear in light of potential changes occurring in the European Community with the advent of Europe 1992 (377). 

In 1983 drugs supplied to the National Health Service amounted to a value of 1 588 m, at manufacturers prices, which was 10.2% of the cost of the whole NHS. Drug costs as a percentage of the NHS budget have varied little in the last two decades. In addition 330 m worth of household medicines were sold in the UK. Pharmaceutical imports amounted to 470 m whereas exports were 1 074 m, leaving a positive trade balance of 604 m. 

Employers the National Health Service (NHS) and in industry for medical device manufacturers and pharmaceutical companies. 

The PBAC and PBPA also consider the prices of pharmaceuticals listed imder Section 100 of the National Health Act, which allows for an alternative means of providing an adequate pharmaceutical service in circumstances where pharmaceutical benefits cannot be conveniently and efficiently supplied in the usual manner under the PBS. Drugs in this category, such... 

Health sector development is a vital government obligation. In a national health system, proper use of well known and newer essential medicines for priority health problems depends on certain minimal level of medical and pharmaceutical services. This includes inexpensive diagnostic test to confirm diagnosis, and well-informed trained clinicians, pharmacists, nurses and other health staff to help patients, especially those with chronic illnesses, to adhere to their treatments. An overall capacity strengthening of the health and supply systems is a pre-requisite to respond adequately to the increased medical and pharmaceutical needs of populations. 

FigurG 3.1. The process of pharmaceutical drug discovery and development—an integrated science that draws on the collective knowledge and resources from both government and private sectors. Abbreviations NIH, National Institute of Health NSF, National Science Foundation PHS, Public Health Service.

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