As we regularly refer to how the NHS decides what medications to fund, I thought it worthwhile to describe how drug funding works in the UK. It is pretty complicated so at the lowest level of detail I would summarise as follows.

In the UK, drug funding depends on where and how the treatment is prescribed—through the NHS, private healthcare, or research programs. Here’s how different types of drugs, including biologics for severe asthma, are funded:

1. NHS Funding (Primary & Secondary Care)
Most medicines are funded through the NHS, but how they are approved and prescribed varies:
a) NICE & SMC Approval (England & Scotland)
  • The National Institute for Health and Care Excellence (NICE) assesses whether a drug is cost-effective for NHS use in England and Wales.
  • In Scotland, the Scottish Medicines Consortium (SMC) performs a similar role.
  • If approved, the drug is added to NHS formularies, meaning it can be prescribed and funded.
b) Individual Funding Requests (IFRs)
  • If a drug is not routinely funded, a clinician can apply for Individual Funding Requests (IFRs) to request NHS coverage in special cases. These funding requests are made to your local NHS Integrated Care Board (ICB) (England – other UK countries have their own systems) who are responsible for managing drug costs
c) High-Cost Drugs & Specialist Prescribing
  • Some biologics (e.g., Benralizumab, Mepolizumab, Tezepelumab) are classified as high-cost drugs and can only be prescribed in specialist NHS clinics, such as severe asthma centres.
  • NHS England funds these under commissioned services, separate from standard GP prescribing.
2. Prescription Charges in England
  • In England, most adults pay £9.65 per prescription item (2024 rate).
  • However, many patients qualify for free prescriptions (e.g., those with long-term conditions, low income, or exemptions).
  • Prepayment Certificates (PPCs) allow unlimited prescriptions for a fixed cost.
💡 Scotland, Wales, and Northern Ireland offer free prescriptions to all residents.
3. Private Prescriptions & Insurance
  • Private healthcare patients must pay the full cost of their medication unless covered by private insurance.
  • Some private insurers (like Bupa, AXA, or Vitality) partially or fully cover biologics if deemed medically necessary.
4. Clinical Trials & Early Access
  • Some new biologics not yet NHS-approved can be accessed through clinical trials.
  • The Early Access to Medicines Scheme (EAMS) allows patients with severe conditions to access promising new treatments before full approval.
5. Hospital Funding (Secondary Care)
  • Some high-cost drugs are funded directly by NHS England or hospital trusts rather than standard NHS prescription budgets.
  • These include biologics that must be administered in hospital settings (e.g., Reslizumab).
Summary
  • NICE/SMC decides which drugs get NHS funding.
  • Some biologics require specialist clinics.
  • Prescriptions are free in Scotland/Wales/NI but cost £9.65 per item in England.
  • Private prescriptions & insurance are alternatives for non-NHS-funded treatments.
  • Clinical trials or EAMS may offer early access to new drugs.

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