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NICE’s chief Dillon says U.S. could ‘learn something’ from UK healthcare, responding to Trump’s ‘freeloading’ accusations

by Natalie Morrison
LONDON, 8 Mar (APM) - NICE’s chief Sir Andrew Dillion has challenged U.S. healthcare policymakers to look at the UK’s drug pricing processes, insisting “there might well be something to learn in doing that”.
He also commented on President Donald Trump’s assertions that U.S. patients pay the highest drug prices of anywhere in the world because countries elsewhere - such as in Europe - are “freeloading” off them with lower prices (APMHE 60322).
Asked about this view, Dillon said he believes the cost of doing business in the U.S. - particularly the massive costs of direct-to-consumer advertising - is a big factor.
He said: “It is absolutely not my place to comment on President Trump, or his observations, or the way the U.S. goes about affording its healthcare system. But I would say the enormous cost of direct-to-consumer advertising in the U.S. - which I’ve heard described as being more than the total cost of research and development for new treatments in the U.S. - must be a factor in what Americans have to pay for their treatment.”
Dillon went on to turn the tables on the drugs industry, insisting its expectations must be scrutinised.
Before asserting that Europe or anywhere else must pay more for their healthcare to redress the balance, he said: “We need to take a long, hard look at the business model of the industry, about its costs, about its expectations for a return on the investment that it makes and on the cost - particularly in the U.S. - of doing business, including direct-to-consumer advertising.”
Dillon was speaking on Thursday at a Health and Social Care Committee hearing on the stalemate between UK health assessor NICE, the NHS and Vertex over cystic fibrosis drug Orkambi (lumacaftor+ivacaftor).
The parties have been unable to reach an agreement in the three years since NICE first said no to access (APMHE 47016), with NICE and the NHS deeming Vertex’s price demands too high.
It was originally set at £104,000 per patient per year when NICE first rejected Orkambi in 2016, though Vertex’s suggested prices since this time have been confidential (APMHE 62149). The company has argued it has offered the NHS the “best price in the world” for its treatment.
Quizzing Dillon on Trump’s comments, UK Labour MP and member of the Health and Social Care Committee, Ben Bradshaw, said: “The reason the drug prices are so high in America is nothing to do with the fact they’re low here, it’s the American healthcare system is highly inefficient, very expensive.
“They spend more than twice as much of the proportion of GDP on health because of all that waste and duplication and yet the president of America is trying to blame us for his inflated drug prices. There is a political agenda here, isn’t there?”
Dillon responded by saying every country needs a forensic, objective, transparent, inclusive and fair process for deciding what to pay for new treatments.
“That’s what we’ve got here in the UK, so my recommendation to the U.S. healthcare system is; if you want to review what it is that you’re paying for life sciences products, then take a look at the processes that are in place here in the UK for determining a fair price for those products, and there might well be something to learn in doing that.”

Invalidating Vertex’s Orkambi patents

Bradshaw went on to ask another UK healthcare head present at the meeting - John Stewart, the national director of specialised commissioning for NHS England - about a campaign from patients and MP Bill Wiggin to invalidate Orkambi’s patent in the UK through a legal provision known as ‘crown use’ licensing, thus clearing the way for generics.
When the campaign was first brought to Parliament last month (APMHE 61710), the UK’s Parliamentary Under-Secretary of State for Health and Social Care, Steve Brine, warned that doing so is not a “quick solution” to access. He also highlighted flaws in the plan, including the fact a generic would take years to develop and that it would reduce trust in the UK for life science companies (APMHE 61753).
Stewart echoed his sentiment that crown use licensing was not the best way forward.
Bradshaw asked: “Given the way Vertex and President Trump are behaving, why are you so reluctant to consider setting aside Vertex’s patents?”
Stewart’s replied that the “far quicker” routes to access is for Vertex to “accept our offer” and “re-engage with the NICE appraisal process”.
Though he conceded that patients’ frustration is understandably “unbearable”, he stressed “crown use licensing is not going to happen quickly - we want patients to get access much quicker than that”.
Ultimately, crown use licensing is a matter for the Department of Health and Social Care, Stewart added, not for NHS England.
The Health and Social Care Committee chair Dr Sarah Wollaston also asked whether one option could be to refer Vertex to the Competition and Markets Authority “given their monopoly position”, to which Stewart said: “Yes, I suspect it could be.”
The NHS would “have to look into” whether there could be a case for that, however, he said.
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