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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 September 1; 335(7617): 452.
PMCID: PMC1962887
Drug Tales and Other Stories

Slowly, the monster dies

Ike Iheanacho, editor, Drug and Therapeutics Bulletin

Not quite 7 years old, the third millennium already has a lot to answer for. Too young to be considered just another time span, its novelty too often triggers anxious navel-gazing and the urge to exaggerate the significance of current events and preoccupations.

Thus all sorts of mundane challenges come to be seen as crises and every tiny step as leaving a giant footprint on history. And this spirit provides a cover for blatant air-brushing, an excuse to pretend that bad practice has suddenly become outdated, rather than never being right in the first place.

Politicians are peculiarly keen to make things “fit for purpose for the 21st century.” This meaningless phrase appears in, and supposedly underlies, the UK government's recent announcement of its intention to reform the Pharmaceutical Price Regulation Scheme (PPRS). The key determinant of NHS spending on branded medicines, this arrangement is both complex and a stranger to public awareness. So although it's existed in various forms for around 50 years, the PPRS remains largely unknown or poorly understood by many affected by its operation.

This opacity partly explains how the PPRS has flourished for so long despite being fundamentally flawed. Whatever its name suggests, the scheme makes no real attempt to dictate, circumscribe, review or otherwise “regulate” the price of individual products according to society's valuation of these treatments. Instead, the scheme centres on regulating the profit drug companies can make, but largely leaves them to decide how to set the price of each medicine in pursuit of this money.

Like many monsters, the PPRS has a good side. By limiting company profits, it has helped to guard against a wholly uncontrolled national drugs bill—an even scarier beast. But this doesn't change the fact that the arbitrary pricing it leads to has always skewed assessments of cost effectiveness and judgments of affordability.

These anomalies are particularly glaring given that other countries have long been able to design, implement, and benefit from effective methods of value based pricing that are far better placed to secure worthwhile beneficial medicines at reasonable prices, while also ensuring that the pharmaceutical industry is rewarded for true innovation.

It has taken an excellent critique of the PPRS from the Office of Fair Trading to push the government into introducing a value based pricing system. Without such a prompt, the scheme might have lumbered on indefinitely. After all, its latest five year incarnation was negotiated with the pharmaceutical industry just three years ago, and was due to run until 2010.

Still, at least things are changing now. And all thanks to the not so new century.

Articles from The BMJ are provided here courtesy of BMJ Publishing Group