I consider that a high cost drug is one wich cost more than one PBI per year. because it costs more that what a country produce per person per year.
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.
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