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> I would argue HTA is not without it's problems. That's why the UK has a cancer drug fund. NICE has said "no" to those drugs, yet the public still clammers for

> I would argue HTA is not without it's problems. That's why the UK has a cancer drug fund. NICE has said "no" to those drugs, yet the public still clammers for them. So a separate funding mechanism was created to pay for them. See also: PrEP. PrEP is available in the US (and covered by almost every private insurer[0] with drug co-pays covered by the manufacturer[1]). And while it's less convenient, there are public clinics where you can get prescriptions to avoid paying the co-pay to a GP. In other words, absent the cost of your time, you can get it in the US for free. In the UK, PrEP is not covered by the NHS. The National AIDS Trust had to sue the NHS just to get them to announce their decision not to cover it - before that, they refused to make a statement one way or the other, and kept kicking the can down the road. Now, you can only get it by paying a private doctor (out-of-pocket) for a prescription, and then fill that prescription privately, which can cost up to $13/pill. (This is technically not HTA, but for the purposes of this discussion that distinction isn't relevant.) [0] And, as an aside, on the rare case that your insurer does not cover it, Gilead (the manufacuter) offers assistance programs that provide it essentially for free. [1] This is a separate program to enroll in; Gilead basically reimburses the co-pays that the insurers charge

DanBC 10y ago
Sexual health is part of public health, and thus we'd expect PrEP to be funded by Public Health England, not the NHS. The target of your anger here should be local authorities (who hold responsibility for Public Health), not the NHS. https://www.england.nhs.uk/2016/11/update-on-prep/ https://www.england.nhs.uk/2016/11/update-on-prep/
- chimeracoder 10y ago
  > Sexual health is part of public health, and thus we'd expect PrEP to be funded by Public Health England, not the NHS.. The target of your anger here should be local authorities (who hold responsibility for Public Health), not the NHS. First, PHE and NHS are both part of the DH, as is NICE. Second, sexual health is one aspect of PrEP, but it's not the full picture (though of course, that's how the NHS press release you linked would be inclined to portray it. The lower court disagreed with that portrayal, even if the appeals court did not.) Finally, the arbitrary delineation of responsibilities in which the NHS is free to wash its hands off of the matter and NICE has no incentive to hold the NHS accountable - leaving patients with no choice but to pay out-of-pocket - is exactly the problem. Meanwhile, PrEP has been generally available (and essentially free) in the US for four years, thanks (ironically) to the federation of power which forces insurers to remain somewhat competitive with each other, and which permits the pharmaceutical companies to pick up the slack when that fails. If you want to point out that this approach has its shortcomings as well, then yes, I'm right there with you. But it's wrong to imply that what NICE and the NHS are doing is fundamentally different from the cost-benefit analyses done in the US, and it's also wrong to ignore the problems with the DH.
vertex-four 10y ago
To anyone interested in getting PrEP in the UK, you can buy it from £39/month upwards without a prescription from a number of online pharmacies. Do your own research, as with taking any medication.

DanBC 10y ago

Sexual health is part of public health, and thus we'd expect PrEP to be funded by Public Health England, not the NHS. The target of your anger here should be local authorities (who hold responsibility for Public Health), not the NHS. https://www.england.nhs.uk/2016/11/update-on-prep/ https://www.england.nhs.uk/2016/11/update-on-prep/

chimeracoder 10y ago
> Sexual health is part of public health, and thus we'd expect PrEP to be funded by Public Health England, not the NHS.. The target of your anger here should be local authorities (who hold responsibility for Public Health), not the NHS. First, PHE and NHS are both part of the DH, as is NICE. Second, sexual health is one aspect of PrEP, but it's not the full picture (though of course, that's how the NHS press release you linked would be inclined to portray it. The lower court disagreed with that portrayal, even if the appeals court did not.) Finally, the arbitrary delineation of responsibilities in which the NHS is free to wash its hands off of the matter and NICE has no incentive to hold the NHS accountable - leaving patients with no choice but to pay out-of-pocket - is exactly the problem. Meanwhile, PrEP has been generally available (and essentially free) in the US for four years, thanks (ironically) to the federation of power which forces insurers to remain somewhat competitive with each other, and which permits the pharmaceutical companies to pick up the slack when that fails. If you want to point out that this approach has its shortcomings as well, then yes, I'm right there with you. But it's wrong to imply that what NICE and the NHS are doing is fundamentally different from the cost-benefit analyses done in the US, and it's also wrong to ignore the problems with the DH.

vertex-four 10y ago

To anyone interested in getting PrEP in the UK, you can buy it from £39/month upwards without a prescription from a number of online pharmacies. Do your own research, as with taking any medication.