Why I am moving to Scotland

Last week I was chatting with a consultant and a senior pharmacist about a group of medicines that I feel are quite important. As a bloke there is quite a reasonable chance that I am going to need to use at least one of them at some point in time. Important to me and perhaps the thousands of blokes that are currently taking them.

The opening gambit was – this one comes with a significant rebate – a clear direction to purchase price. This is not the right starting point in a conversation – well at least the London Procurement Programme, in their excellent piece on rebates agrees with me.

But which one would be better for patients? I counter to be told by the consultant that they are all the same – not the reply I expected, but he looks confidently to the pharmacist who nods and smiles.

Hmmm, but they don’t come from the same class of drug and have distinctly different mechanisms of action – have you looked?

OK – so the answer is no. Three papers showing advantages in relapse and survival, one showing significantly better symptom control later, and confirming hat these all come from head to head trials and further analysis of those trials and the comparator is at a dose double of that commonly used in the UK. And the consultant is reading avidly.

But it is significantly more expensive and we just can’t afford it. Just about got me there! Two steps to orbit. So we can’t afford better symptom control and longer disease free progression. But I must try one more approach:

But it is cost dominant at the list price and even more so with the rebate that they offer. A smile from the consultant and a response from the pharmacist – who says its cost dominant?

The SMC in their review 18 months ago.

Well it was still rejected at the D and T. Perhaps I will live longer in Scotland?


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