Multi-indication medicines and their important role in patient care

Under the medicines reimbursement framework in England, the National Institute for Health and Care Excellence (NICE) will assess how much value the medicine offers to patients, their families, and to the NHS. Patients can then get access to a medicine via the NHS once the pharmaceutical company and NHS agree a ‘cost-effective’ price.  

As standard, the NHS permits only one price per medicine. While historically this might have been sufficient for medicines that only treat one disease, it fails to account for the different value that multi-indication medicines bring to different patient groups.

This lack of pricing flexibility means that NHS England often requires a single price for multi-indication medicines that don’t reflect the value or “cost effectiveness” of a medicine to a particular patient group or in treating a particular indication.

This could potentially have contributed to fewer multi-indication medicines being made available to NHS patients than single disease medicines.¹ Research found that between 2014 and 2023, approximately 830,000 patients in the UK missed out on access to a multi-indication medicine.²

The NHS does allow for “indication-specific pricing” (ISP), where a different price is set for each indication in alignment with the value it provides to that patient group. However, indication-specific pricing is only available in exceptional circumstances, when narrow criteria set out in NHS England’s Commercial Framework for New Medicines are met.³

One of the criterions that is particularly challenging is Principle 4 of NHS England’s Commercial Framework for New Medicines, which requires a medicine to provide “additional value at-or-below NICE’s standard cost-effectiveness threshold”.³

In practice this requires a pricing discount on top of a price that NICE has determined represents good value for money or a “cost-effective” price. 

Sanofi is calling on the Government and NHS England to remove the requirement for an indication to provide additional value, to be eligible for an indication-specific pricing agreement. An update to NHS England’s Commercial Framework for New Medicines and all future voluntary scheme Heads of Agreement wording will be required.

As set out in the Government’s Life Sciences Sector Plan, the UK is striving to be world-leading in the development, testing, and uptake of new, innovative treatments.⁴ However, this will only be possible by adopting flexible pricing solutions that enable access to innovation.