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Price Collusion Allegations over Anti-nausea Drug

Four pharmaceutical companies have been accused of colluding to artificially increase the price of a drug used to treat nausea and dizziness by almost 700%.

The Competition and Markets Authority (CMA) alleged that, between June 2013 and July 2018, Alliance Pharmaceuticals, Focus, Lexon, and Medreich agreed not to compete for the supply of prescription-only prochlorperazine 3mg dissolvable buccal tablets to the NHS. The CMA provisionally found that Alliance Pharmaceuticals entered into an agreement to supply its prochlorperazine buccal tablets exclusively to Focus. In separate agreements, Lexon and Medreich agreed not to compete for the supply of the tablets in the UK market, in exchange for a share of Focus' profits on the Alliance preparation.

In a statement of objections, the CMA said that between December 2013 and December 2017, the prices paid by the NHS for prochlorperazine rose from £6.49 per pack of 50 tablets to £51.68. This led to the annual cost to the NHS for the drug rising from £2.7 million to around £7.5 million, even though the number of packs dispensed fell.

Ann Pope, senior director of antitrust at the CMA, said: "Agreements where a company pays a rival not to enter the market can lead to higher prices and deprive the NHS of huge savings that often result from competition between drug suppliers.

"The NHS should not be denied the opportunity of benefiting from an increased choice of suppliers, or lower prices, for important medicine."

The manufacturers now have the chance to make representations to the CMA on its provisional findings before a final decision is reached.

MMR Vaccination Call

Outbreaks of measles prompted Public Health England (PHE) to renew its call for all parents to ensure their children receive the measles, mumps and rubella (MMR) vaccine when it is offered. It said parents should also ask for it now if their children were not vaccinated when originally called.

In the first quarter of 2019, there were 231 confirmed cases of measles in England.

Although this figure is slightly lower than in the same quarter last year, PHE said recently cases of measles are mainly being seen in under-vaccinated cohorts, particularly those with links to countries seeing large outbreaks of measles, including Romania, France, Poland, and Lithuania.

Dr Mary Ramsay, head of immunisation at PHE, said: "Measles can kill and it is incredibly easy to catch, especially if you are not vaccinated. Even one child missing their vaccine is one too many. If you are in any doubt about your child's vaccination status, ask your GP as it’s never too late to get protected.

"There are measles outbreaks happening across Europe so if you are planning to travel, make sure you check with your GP and catch-up if needed."

In the final quarter of 2018 94.9% of eligible children aged 5 received the first dose of MMR. However, coverage for the second dose was only 87.4% for children aged 5.

This quarter, 795 cases of mumps have also been confirmed, PHE said. No new cases of rubella were reported.

Back to Work After Sickness

Draft guidelines on how to help people to return to work after long-term sickness were published by NICE.

The update to the 2009 guidelines on workplace health includes promoting health and wellbeing as a core priority for employers, ensuring that clear procedures are in place for reporting and managing sickness, and collecting data so that the reasons for sickness absence can be monitored over time.

Companies should consider offering external employee assistance programmes if the organisation does not do so in-house, and these might include counselling and physiotherapy to help employees deal with issues that might affect their health and work-performance.

NICE noted that UK employers spend £9 billion a year on sick pay and associated costs. In 2016, 137 million working days were lost due to sickness or injury, according to official figures.

There were also concerns that many employees who took long-term sick-leave do not return to work, and that 45% of claimants of Employment and Support Allowance in England took a period of sickness absence before they left employment.

A consultation on the draft guidelines will run until 5th July, with final guidance due in November 2019.

Inotersen Recommended for Polyneuropathy

In final guidance, inotersen (Tegsedi, Akcea Therapeutics) was recommended to treat stage 1 and stage 2 polyneuropathy in adults who have hereditary transthyretin amyloidosis.

The rare condition can affect the autonomic nervous system, peripheral nerves, heart, gastrointestinal system, eyes, and central nervous system, and can lead to death within 3 to 15 years of symptoms developing.

NICE recognised that hereditary transthyretin amyloidosis severely affects quality of life.

Patients with the condition are usually given supportive care.

The list price of inotersen is £5925 per 284 mg weekly self-administered subcutaneous injection. However, a commercial arrangement is in place for supply to the NHS at a discounted price.

Implants for Prominent Ears

A consultation document was issued by NICE on whether to recommend implant insertion for prominent ears.

It said current evidence on the safety and efficacy of the procedure was inadequate in quality and quantity. For instance, the procedure was most commonly carried out in children and young people, while most of the evidence reviewed came from adults.

NICE did not, therefore, propose to recommend implant insertion for routine NHS use.

Interested parties have until 20th June to submit comments. Final recommendations are expected in September 2019.

Hyperparathyroidism Guidance

NICE published final clinical guidance on the diagnosis, assessment, and initial management of hyperparathyroidism.

It said it drew up the guidelines to ensure:

  • Better awareness about the symptoms and that healthcare professionals know when to test for it
  • People with hyperparathyroidism are diagnosed without delay
  • Doctors have clear advice on when to offer surgery for hyperparathyroidism, and how to use tests to decide the best type of surgery
  • People have follow-up checks as often as needed depending on how their condition is managed

Glaucoma Treatment

Draft guidelines for the use of high-intensity focused ultrasound for glaucoma were put out for consultation by NICE.

The procedure involves using high intensity focused ultrasound (HIFU) to partially destroy the ciliary body to reduce the production of aqueous humor and decrease intraocular pressure.

NICE said that its current position on the treatment was to recommend the procedure in the context of research only, as evidence on its safety and efficacy was insufficient

Following the 4 week consultation period, the independent Interventional Procedures Advisory Committee will review its findings before NICE issues final guidance in September 2019.