What are the implications of the silo fund on market access?

It was very interesting to see last week that NHS England enacted an £18.7 million funding stream to expedite market access for a single medicine – Gilead’s new Hep C drug Sovaldi (sofosbuvir) in combination with the antiviral ledipasvir. The silo fund was originally approved in April and is now ‘open for business’. The recommendation of the body’s Clinical Priorities Advisory Group (CPAG) means that whilst the drug goes through the NICE process, Sovaldi will be funded for those hep C patients at significant risk of mortality – or who require liver transplantation.’

Consequently many patients with acute liver failure or awaiting transplants can gain early access to Sovaldi whereas previously they would have had to have waited for NICE approval. This is the second time the NHS has intervened to fund a particular disease – following the Cancer Drugs Fund (CDF) but it’s the first time a single drug has been given its own unique cash stream.

Ben Adams has written an excellent article covering this that’s worth a read in the PharmaFocus Market Access supplement

In parallel to this, last week Sir Andrew Dillon, Chief Executive of NICE, is reported in PharmaTimes to have said ‘NICE vs. CDF makes no sense’. He told the Health select Committee that there was a misalignment in the approach NICE takes regarding willingness to pay vs. the CDF. An example of this is Roche’s Kadcyla (trastuzumab emtansine). NICE rejected the drug to treat women with aggressive breast cancer last month based on an assessment of QALY – but the drug can be accessed through the CDF.

We've been mulling over some questions in the office this week about this...

How will NICE, the CDF and Silo funds work together in the future? Which other new, exciting drugs outside of oncology might go down the route of these new silo funds? And what will this mean for NICE – how will the NHS ratify their decisions between the different channels?

This could be a new opportunity for patients to gain access to life-changing medicines that previously may not have been available to them, but there’s also the potential for it to become a whole new political hot potato!