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An update on access to bisphosphonates

Our Campaigns team give you an update on patient access to bisphosphonates and the impact our campaigning has had on NHS Trusts.

Our Campaigns team give you an update on patient access to bisphosphonates and the impact our campaigning has had on NHS Trusts.

What are bisphosphonates?

Bisphosphonates are a group of drugs which strengthen the bone and are licensed to treat osteoporosis and to reduce damage to the bone for people with cancer in their bones.  

In 2015 evidence was published in the Lancet (a peer-reviewed general medical journal) which showed that for post-menopausal women with early breast cancer, bisphosphonates reduced the risk of both breast cancer spreading to other parts of the body - where it becomes incurable - and of dying from the disease.

It is estimated that over 1,000 breast cancer deaths could be prevented (10% of all breast cancer deaths) – and around £6 million saved by the NHS –for each group of patients that start taking bisphosphonates each year, if they were prescribed to all postmenopausal women.

Access to bisphosphonates

Drugs normally find their way to patients by getting a licence for use in the condition they have been developed to treat, and a recommendation for routine use on the NHS from the National Institute of Health and Care Excellence (NICE) - or, in Scotland, the Scottish Medicines Consortium (SMC).

After a period of time the patent on drugs, like bisphosphonates, expires and they become ‘off-patent’. Manufacturers other than the company that developed the drug can then make and sell it. This leads to competition between manufacturers which ultimately drives the price down and makes the drug more widely available at a cheaper price.

When research finds new uses for off-patent drugs like bisphosphonates there is no commercial incentive for pharmaceutical companies to pursue a licence for the new use, and no clear mechanism for the new use to be approved for funding  Clinicians can prescribe drugs for uses for which they are not licensed (known as prescribing ‘off label’), but as these decisions are taken on a case-by-case basis, access to off-patent drugs for patients can be inconsistent.

What steps have been taken?

Thousands of you campaigned with us in 2016, calling on the Health Secretary to resolve the uncertainty around commissioning responsibility for bisphosphonates.

Since then NHS England’s Breast Clinical Expert Group produced clinical advice recommending the use of bisphosphonates and NICE published updated clinical guidelines on early and locally advanced breast cancer that recommends bisphosphonates for women at high risk of recurrence.

What does the picture look like now?

In early 2018 it was announced that bisphosphonates were available for post-menopausal women at high risk of recurrence in both Scotland and Wales. In England we sent requests under the Freedom of Information Act (FOI) to NHS Trusts to find out whether they are now routinely providing bisphosphonates.

Overall, out of 132 Trusts who have a breast cancer service, bisphosphonates are now being routinely provided to patients in 124 Trusts (94%). There are 4 Trusts (3%) in the process of making them available and 4 remaining Trusts (3%) who are yet to respond or were unclear in their response as to whether they provide bisphosphonates.

What next?

It is great that the vast majority of Trusts are now routinely providing bisphosphonates to post-menopausal women.  A big thank you to all who supported our campaign. Your support has been vital to the progress that has been made in getting this issue on the agenda and helping us to reach the point that we are today.

We will continue to work with the handful of remaining Trusts who have not responded to us, or whose responses were unclear to ensure that post-menopausal women in those areas who could benefit from bisphosphonates have access to them.

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