BSW Area Prescribing Committee

High Cost Drugs and Devices

High Cost Drugs excluded from the National Tariff of Payment by Results

There are a number of High Cost Drugs and Devices that are excluded from the Payment by Results (PbR) tariff. They are typically specialist drugs and the commissioning arrangements for these drugs is to ensure their safe, effective and appropriate use within available funding.

Following the reorganisation of the NHS, from April 1st 2013, PbR Excluded Drugs are either; Commissioned by NHS England Or Commissioned by Clinical Commissioning Groups.

A comprehensive list of medicines not reimbursed through the national prices and directly commissioned by NHSE is available here
A list of medicines and approved indications not reimbursed through national prices and commissioned by CCGs / NHSE within the BSW locality is available here.

Prior Approval via Blueteq is required for many HCD and Devices. Information can be found on the Blueteq website (login is required)

A technical document is available which describes the prescribed specialised services, some of which are directly commissioned by NHSE and some by CCG’s.

For a detailed list of the NHS National Tariff Payment System click here

Exceptional Cases If an individual falls outside the range of services and treatments that the CCG has agreed to commission then an Exceptional Funding Request can be made by a clinician, on behalf of a patient, to fund healthcare. The responsibility for demonstrating exceptional lies with the requesting clinician and based on the information provided the CCG must decide whether or not to support this view and agree to fund the request. The form can be accessed here

Cancer Drugs Fund NHS England are the responsible commissioners for the Cancer Drugs Fund (CDF). The CDF is a source of funding for cancer drugs in England. To see which treatments are currently funded by the CDF, please see the Cancer Drugs Fund List
Free of Charge Schemes A free of charge medicines scheme is defined as an arrangement where a UK licensed or unlicensed medicine is provided free of charge by the company to an individual patient* or an identified cohort of patients. BSW APC has a FOC Policy and process for decision making based on RMOC guidance.

A significant proportion of high cost drugs excluded from tariff are commissioned by BSW CCG in line with NICE Technology Appraisals (from day 90).

Biologic algorithms for use in Dermatology, Gastroenterology, Ophthalmology and Rheumatology can be found on Blueteq page.