What do Nice and SMC
do?
NICE weighs up the evidence on how well a medicine works and how
much it costs. It then recommends whether or not the medicine
should be available on the NHS in England, Wales and Northern
Ireland. It can take several months for NICE to come to a decision.
If you live in England, Wales or Northern Ireland, your local
healthcare provider has to provide any medicine that is recommended
by NICE, if it is a suitable treatment for you. The SMC do a
similar job to NICE in Scotland.
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Can I get a medicine on the NHS
before NICE and SMC have reccommended it?
Your local healthcare provider may choose to make a licensed
medicine available on the NHS before it is recommended by NICE or
SMC. This means that your doctor can prescribe the medicine for
you, so long as they think it is suitable for you, and you decide
you want to have it.
If your local healthcare provider will not make a licensed
medicine available on the NHS before it is recommended by NICE or
SMC, your cancer specialist may still be able to get the medicine
for you.
How they do this depends on where you live:
If you live in England, your cancer specialist can apply to the
Cancer Drugs Fund. You can read more about this in the sections
below. If you live in Wales, your cancer specialist can apply to
your Local Health Board. You may hear this called an exceptional
funding request. Ask your cancer specialist for more
information.
If you live in Northern Ireland, your cancer specialist can apply
to your local Health and Social Care Trust. You may hear this
called an exceptional funding request. Ask your cancer specialist
for more information.
If you live in Scotland, your cancer specialist can apply to your
Local Health Board. You may hear this called an individual funding
request. Ask your cancer specialist for more information. You may
also be able to get the medicine by taking part in a clinical
trial.
To find out if there are any clinical trials that would be
suitable for you, you can:
- Ask your specialist team
- Call our confidential Helpline
- Search the Cancer Help UK clinical trials database
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What is the Cancer Drugs
Fund?
The Cancer Drugs Fund is money the Government in England has put
aside to pay for cancer medicines that are licensed but have not
been approved by NICE and are not available on the NHS in your
area. It covers:
- Medicines that have not yet been looked at by NICE
- Medicines that NICE are currently looking at
- Medicines that NICE have looked at and said do not work well
enough, or are not cost-effective
- Medicines that NICE have looked at but have only recommended
for a very specific group of patients
The aim of the fund is to allow people with cancer to get the
medicines that doctors think will help them.
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How do I apply to the Cancer
Drugs Fund?
If your cancer specialist thinks a medicine is suitable for you
and you decide you want to have it, your cancer specialist will
need to apply for you to your local strategic health authority
(SHA). You cannot apply directly yourself. Your local SHA is the
organisation that manages the NHS in your area, on behalf of the
Government. There are ten SHAs spread across England. You can find
more information about SHAs and how the NHS is structured at NHS
Choices.
Your cancer specialist may need to apply to your local healthcare
provider (primary care trust or PCT) before they apply to your
local SHA. As the Cancer Drugs Fund is fairly new, your specialist
may not be familiar with the application process. Some specialists
may think they can only apply for funding for medicines which are
on the list of medicines that your SHA have already decided they
will pay for, known as the priority list (see the section below,
How does the Cancer Drugs Fund work?). However, your specialist can
apply for medicines that are not on this list.
If your specialist is unclear about the application process, you
can suggest they look on the website for your local SHA. CancerHelp
UK has a list of SHAs and their websites.
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How does the Cancer
Drugs Fund work?
Your local strategic health authority (SHA) will have a group of
cancer specialists called a Cancer Drugs Fund panel, who decide
which medicines should be available through the Cancer Drugs Fund
in your area. Most SHAs have a list of medicines, called a priority
list, which the panel have decided they will pay for. Each SHA will
have its own priority list and it may change from time to time as
new medicines become available. For each medicine on the list,
there are usually guidelines about who the medicine is suitable
for.
If the medicine your cancer specialist is applying for is on the
priority list for your SHA, and you are suitable for treatment, it
is likely that you will be able to have the medicine.
If the medicine is not on the priority list, what happens next
depends on your SHA:
In some areas, you will not be able to have the medicine
if it is not on the list. Your cancer specialist can apply
to your local healthcare provider (primary care trust or PCT) to
try to get exceptional funding for the medicine, also known as an
individual funding request (IFR). Ask your specialist for more
information.
In other areas, the Cancer Drugs Fund panel makes a
decision on whether or not you can have the medicine. They
look at several things, for example, why your specialist thinks you
need the medicine, what other treatments are available, evidence
about how well the medicine works and its side effects, and how
much the medicine costs.
Ask your cancer specialist for more information about the Cancer
Drugs Fund in your area. You can also get more detailed information
on the Cancer Drugs Fund, including a list of SHAs and their
websites, from CancerHelp UK. The website for each SHA should
provide the list of medicines funded by the Cancer Drugs Fund in
that area and information on the application process.
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How long will I have to wait for a
decision on my Cancer Drugs Fund application?
This can vary from one strategic health authority (SHA) to
another. If the medicine your cancer specialist is applying for is
on the priority list for your SHA, the SHA may reach a decision
quite quickly, for example, within a few days. But it can take
longer, particularly if the medicine is not on the priority list
for your SHA. The Government have said that a decision should be
reached within 31 days.
Your specialist should tell you how long the process is likely to
take in your area. If the decision is no, you will be given clear
reasons why. Your specialist can appeal against the decision if
they believe the panel has overlooked important information or if
your condition changes.
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