Restrictions on the use of higher cost drugs for rheumatoid arthritis in England: Surveys of Clinical Commissioning Groups; prescribers

Walker, David; Barry, Jane; Akroyd, Laura; Robinson, Sandra

doi:10.1002/msc.1767

Cited by 2 publications

(3 citation statements)

References 8 publications

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“…The cost/ benefit of a partially effective drug is, by definition, worse. This study supports the survey data (Walker et al, 2023) and confirms the extent of the impact of the restriction of HCDs and how unacceptable it is both professionally and for patients. Furthermore, patients expressed clear distress even at the thought of drug restriction past three prescriptions, which illustrates an entirely unsatisfactory situation.…”

Section: Discussionsupporting

confidence: 86%

“…Five semi-structured interviews were conducted with rheumatology consultants who were working in restricted areas and who had volunteered to be interviewed following a national survey of high-cost drug prescribers in rheumatology (Walker et al, 2023). This was a convenient sample of those who volunteered.…”

Section: Methodsmentioning

confidence: 99%

“…There is an assumption that the primary purpose of the restriction of drug use was to save money. However, in our survey of prescribers (Walker et al, 2023), it seemed likely that patients were remaining on partially effective treatments in order that they did not run out of choices. We were interested in exploring the views of the prescribers in more detail with qualitative interviews on the impacts and effects of these restrictions.…”

Section: Introductionmentioning

confidence: 96%

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Qualitative assessment of the impact of restricting number of drug treatments for rheumatoid arthritis: Experience of prescribers and patients

Walker,

Robinson

2023

Musculoskeletal Care

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IntroductionIn 2020, almost half of all Clinical Commissioning Groups in England were restricting the number of higher cost drugs (HCDs) that could be prescribed for Rheumatoid Arthritis (RA) before an Individual Funding Request was required. We were interested in qualitatively exploring the experiences of prescribers affected by these restrictions and the experiences of patients who required four or more of these drugs.MethodsSemi‐structured interviews were conducted with five prescribers in restricted areas and six patients from our own service who had received four or more HCDs. The interviews were analysed thematically.ResultsPrescribers reported feeling distressed and frustrated by the unsatisfactory service they were constrained to provide. Some prescribers continued partially effective treatments in order not to run out of options. They did not find Individual Funding Requests or the Blueteq High Cost Drug (HCD) System helpful in the management of these patients. The Blueteq HCD System is an electronic platform that allows health managers to monitor the prescribing of high‐cost medicines and manage the complexities associated with their use. Patients expressed severe distress at the prospect of running out of options and anxiety around the process of gaining approval for their next treatment.ConclusionsRestricting drugs for RA by the number which can be prescribed results in persistence with partially effective treatments, which is unsatisfactory for prescribers and patients, further it does not save money. Patients need to travel in their journey with RA and be able to try the next drug even though they know that it may not work.