If you live in the US, then you’re no stranger to the corner pharmacy because there are at least two on every corner. Slight exaggeration, maybe. Pop quiz, how many pharmacies does CVS have? The answer can be found at the end of this article or you can click on this to see an infographic of just how large and powerful the top US pharmacies are. “But, I’m British.” Ok, go here to see how the growth in the volume of prescriptions dispensed is far greater than the rise (or fall) in NHS funding. We bring this to your attention because of the potential impact pharmacies can and do have on delivering healthcare. Back to CVS, they have almost 1,000 in-store MinuteClinic locations. BTW, CVS has 9,207 pharmacies in the US which averages to ~3 for every US county.

Hawking says no to NHS ACOs

NHS England is considering plans to create accountable care organizations responsible for uniting various health services in a region. The idea is being put forth as a way to encourage teamwork across clinicians at those various services, which would ideally translate into better health outcomes for patients. But critics like Stephen Hawking are concerned that this is a slippery slope into healthcare privatization, and so they’re taking UK Health Secretary Jeremy Hunt to court. They allege there’s no legal basis for NHS England to go through with its plans, and it would take an act of Parliament to make it above-board. This is all happening in the midst of NHS budget cuts which led thousands to march in London on Saturday. Y’all alright NHS?

Kilt or no kilt, the Scotts are tough

Earlier this week the Scottish Medicines Consortium (SMC) rejected NHS funding for four new therapies, including Bristol-Myers Squibb and Roche’s cancer medicines Opdivo and Gazyvaro. If you don’t know, those are pretty popular drugs. Opdivo recorded $1.2B in worldwide sales in the 2nd quarter of 2017 (that’s ~$13.3M per day). The reason for the rejections? Lack of evidence that the price justified the effectiveness (vs. current treatments). The SMC’s decisions mirror those made by NICE, which rejected their use in England and Wales. Hard to argue with the logic, but we just can’t help but ask; If these medicines were made by Scottish drug makers, would they be approved? Because we all know, if it’s not Scottish, it’s crap. Either way, drug makers better bring their cost-effectiveness A-game if they want future approvals.

I hope the ATM fees are refunded

According to NHS Providers, a group that represents 97% of hospital, mental health, community and ambulance service trusts in England, the NHS needs an immediate cash injection of between £200 and £350 million to manage the risk associated with a projected “bad” winter in England. For some encouraging reading, see their Winter Warning publication. So, winter coming, there’s a physician and nurse shortage, A&E (think emergency room for our American readers) wait times are up, and previous programs have not produced enough efficiencies. Any good news? Yes. Apparently planning and support is “considerably more developed” than last year. Great, there’s a plan. Here’s hoping the winter is not too bad. Keep calm and show me the money.

A not-so-NICE decision for Eisai

Earlier this week the National Institute for Health and Care Excellence (NICE) said it is not recommending NHS funding for Eisai’s Kisplyx (lenvatinib) plus everolimus for treating advanced renal cell carcinoma in adults who have had one previous vascular endothelial growth factor (VEGF)-targeted therapy. The reason? “The cost-effectiveness estimates compared with all comparators were much more than what NICE normally considers acceptable (£30,000 per quality-adjusted life year gained).” Gotta hand it to NICE, a rule is a rule. The decision did recognize there was a 10.1 month improvement in life expectancy, but this figure was based on a small sample size in the clinical trials. While we’re not market access experts, good chance Eisai will be firing up some RWE/HEOR/Late-phase studies fairly soon.

Safe T first

Yay, we get to write another article about fewer needles in the lives of diabetics! Researchers in London are working on an immunotherapy approach to slow down the progression of Type I Diabetes, which would ideally result in a future where those diabetics won’t have to inject insulin daily. The disease works by attacking insulin-producing cells, so the scientists decided to try to get the lazy part of the immune system that wasn’t stopping that—regulatory T cells—to stop playing video games and get a job! (Sorry. Too close to home?) The scientists proved the safety of this approach in a recent Phase I study, so it will be a while before anything is marketed to the general public, but we just think this immunotherapy stuff is the bee’s knees.

UK to dramatically improve mental health care

Longtime Insight City readers beware, we really can’t use our normal voice/style for this article. But don’t think we didn’t think about it. Earlier this week UK NHS Health Secretary Jeremy Hunt launched a plan to expand the country’s mental health treatment efforts. And not just any plan. The NHS has committed £1.3 billion to transform mental health services, with a pledge to: (1) treat an extra 1 million patients by 2020 by hiring ~21,000 more workers, (b) provide services 7 days a week, 24 hours a day, and (iii) integrate mental and physical health services for the first time. Yep, 1.3 billion pounds. That’s like 650,000 tons of money. You do the math. To get you up-to-speed, see the most prevalent mental illnesses in the UK here.

1. About that new drug you wanted…

Beginning in April of this year, NHS England will have the ability to withhold patient access to select approved medicines, according to The Times. Even if NICE considers a new drug of appropriate value, it may be withheld or rationed if it costs the NHS more than £20 million per year. While this might not be too alarming for those seeking help to lower cholesterol, the prospect of a drug being withheld for a rare disease – even if it is considered good value – is no bueno. Or what if one of the many potential Alzheimer’s drugs in development works? The size of the addressable patient population could make the £20 million threshold look puny. Stay tuned for more unpopular decisions to come.