Individual funding requests and exceptionality: Does the Cancer Drugs Fund have anything to learn from PCTs?


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A Ford1
1Clatterbridge Cancer Centre, Merseyside, UK

Background

Primary Care Trusts (PCTs) were mandated to fund all drugs approved by the National Institute for Health and Clinical Excellence. No such obligation existed with respect to other treatments, but English law dictated that any PCT policy of not funding a treatment must allow for the possibility of exceptions to that policy. To meet this requirement, PCTs, now replaced by Clinical Commissioning Groups (CCGs), established Individual Funding Request (IFR) panels to assess patients’ claims of exceptionality. This study is the first to examine how exceptionality is determined. Historically, the majority of IFR applications were for cancer drugs.

Method

Thirty IFR panel members from 5 PCTs participated in semi-structured interviews for this qualitative study. Interview transcripts were analysed using Framework Analysis.

Results

Clinical factors were of overriding importance in the determination of exceptionality. Cost effectiveness was generally only considered after exceptionality had been established, if at all. Age and social factors were considered in some circumstances. External influences included the media, the presence of patients at panel meetings and the risk of legal action by patients.

Conclusion

The study reveals the inherent difficulty of achieving consistency in the determination of exceptionality, which by its nature involves discretional decisions. The need to ensure that the experience of IFR panels is not lost with the transition of PCTs to CCGs is highlighted.

The findings are particularly relevant to those practising in Oncology because the national Cancer Drugs Fund has recently established a similar process for considering Individual Cancer Drugs Fund Requests (ICDFRs). For drugs which have not been prioritised for the national CDF Cohort Policy List, clinicians may apply to the CDF for funding on the grounds of clinical exceptionality. This study provides insight into how the CDF may interpret this concept and questions whether the CDF has anything to learn from PCTs.