Request for a New Medicine: Overview
CCGs are increasingly being requested to fund new and innovative treatments by clinicians and patients. in an era of finite resources It can not be expected that new medicines are introduced in an ad hoc basis through the mechanism of individual case funding. To do so would risk inequity, since the treatment would not be offered openly and equally to all with equal clinical need. It would also risk diverting resources in such a way that would destabilise other areas of healthcare identified as priorities. Therefore, decisions on the introduction of new medicines will take place on a population level, within the established planning frameworks of the NHS after consideration by the appropriate committees.
Any NHS healthcare professional working within the East Lancashire health economy can request that the MMB considers an application to assess a new medicine, and prioritise it against other competing requests.
Where a clinician is considering requesting an intervention for a patient that is not already commissioned, but this patient represents the first of many, this will be considered only as a Service Development. As such, the clinican should request the intervention for all patients, The process for applying for a medicine to be reviewed as a service development by the MMB can be found below with the application form for a 'New Product, or Change of Regimen' and guidance relating to the governance arrangements of documents submitted to East Lancashire Medicines Management Board.
Individual Funding Requests and Exceptional Cases
Individual Funding Requests: Where no policy exists for a very rare condition or experimental medicine
The CCG have set up an Individual Cases process to consider the circumstances of individuals, for whom a referral outside existing pathways may be appropriate. This usually relates to patients with rare conditions, or for more experimental treatments where there is very sparse evidence. in such instances Clinicians should obtain an individual funding request form- see below.
Exceptional Cases: Where a policy not to fund a medicine is already in place
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 exceptionality 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.
Should you wish to apply for exceptional funding please use the form below.