High Cost Drugs and Devices - 2019

Overview

Some high cost drugs and devices are paid for in addition to the national price for the related service.

As medical practice changes and new drugs and devices are developed and adopted, the lists of high cost drugs and devices needs to be kept as current as practically possible, requiring input from the health sector for changes to the lists, both additions and removals.

We are now inviting nominations for additions to, and removals from, the high cost drugs and devices lists for the next national tariff, due to come into effect in April 2020.

When considering which items to include in the lists for the next national tariff, our guiding principle is that the drug or device should be high cost and represent a disproportionate cost compared to the other expected costs of care within the Healthcare Resource Group (HRG) or Treatment Function Code (TFC) which would affect fair reimbursement. We recognise however that for some new drugs or devices it can be difficult to produce cost and usage estimates, and so we will consider all relevant information available that will help to inform recommendations. We also recognise that there may be circumstances where it is beneficial to the service to add or retain devices on the high cost list in order to support procurement arrangements introduced by NHS England Specialised Commissioning.

We would expect any nominations for drugs or devices to be added to the high cost list to relate to items that are either not currently in use or have only recently come into use.