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High Cost Drugs exc from tariff

High Cost Drugs excluded from the National Tariff of Payment by Results

There are a number of High Cost Drugs that are excluded from the Payment by Results (PbR) tariff. They are typically specialist
drugs and the commissioning arrangements for these drugs is to ensure their safe, effective and appropriate use within available 
Following the reorganisation of the NHS, from April 1st 2013, PbR Excluded Drugs  are either; 

          >      Commissioned by NHS England
          >      Commissioned by Clinical Commissioning Groups.
A comprehensive list of medicines not reimbursed through the national prices and directly commissioned by NHS England is 
available here - (version 14, published April 2019)
A technical document is available which describes the prescribed specialised services, some of which are directly commissioned by 
NHS England and some by CCG's. This Manual can be accessed here
For a detailed list of the NHS National Tariff Payment System for 2019 to 2020 click here
Exceptional Cases
If an individual falls outside the range of services and treatments that the CCG has agreed to commission then an Exceptional 
Funding Request can be made by a clinician, on behalf of a patient,  to fund healthcare. The responsibility for demonstrating 
exceptional lies with the requesting clinician and based on the information provided the CCG must decide whether or not to
support this view and agree to fund the request. The form can be accessed here

Cancer Drugs Fund
NHS England are the responsible commissioners for the Cancer Drugs Fund (CDF).  The CDF is a source of funding for cancer drugs 
in England To see which treatments are currently funded by the CDF, please see the Cancer Drugs Fund List
Patient Access Schemes
Patient Access Schemes are pricing agreements proposed by pharmaceutical companies to enable patients to gain access to 
high cost drugs that are not likely to be approved by NICE for use in the NHS because they are expensive and do not have 
a significant benefit over existing treatments.
For a list of technologies with approved Patient Access Schemes click here
A significant proportion of high cost drugs excluded from tariff are commissioned by East Lancashire Health Economy in line with
NICE Technology Appraisals. Biologic algorithms for use in Dermatology, Gastroenterology, Opthalmology and Rhematology are 
listed below:

All material in this section is aimed at health care professionals, but is information currently held in the public domain, members of the  
public seeking advice on medicine-related matters are advised to speak with their GP, pharmacist, nurse or contact NHS111 Service. 
  Email: info.elmmb@nhs.net
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