High cost drugs

Some high cost drugs should be paid for through a separate price negotiation and paid in addition to the national price for the related service. They are typically specialist, and their use is concentrated in a relatively small number of centres rather than evenly across all trusts that carry out activity in the relevant HRGs. These drugs would therefore not be fairly reimbursed if they were funded through the tariff. For all listed activity, commissioners and providers should agree local prices.

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

Below is a link for organisations to nominate high cost drugs for consideration

Add your nomination using our high cost drugs portal.

Although the portal is open to submissions all year round, the deadline for nominations through this portal for consideration in the proceeding year’s National Tariff is the 31 January, to allow time for consideration and the relevant impacts to be processed, i.e. for 2016/17 Tariff the deadline would be 31 January 2015.

The high cost drug steering group uses the following guidelines when considering a drug for inclusion on the high cost drug exclusion list:

  • the drug and its expected associated costs of care are disproportionately high cost compared to the other expected costs of care within the HRG, which would affect fair reimbursement;
  • there is, or is expected to be, more than £1.5 million spend or 600 cases in England per annum;
  • Drugs which no longer meet the criteria, and so will not lead to systematically incorrect reimbursement of providers will be considered for removal from the high cost list.

Other points to note are that:

  • high cost drugs are defined by the cost of the average expected use or unit of the drug. Low cost drugs, irrespective of prescribing volumes, will not be considered for inclusion on the High Cost Drug list;
  • a high cost drug is a high cost drug irrespective of reason for prescription, though DH may choose to exclude certain drugs from National Tariff for specific indications;
  • when a decision is made to exclude a high cost drug from National Tariff, it is added to the list using its British Approved Name (where available);
  • if a drug does not appear on the high cost drug list, then it is within the scope of National Tariff, unless it is part of an listed procedure;
  • the Oncology Regimens (OPCS 4 Chemotherapy Regimens) list of drugs is maintained by the Oncology Regimens Steering Group and has a separate portal for nominations.

The high cost drugs request portal should not be used for high cost devices or chemotherapy. These have separate portals available from: