Prescription Drugs by Lottery

Published December 1, 2001

How do the British address prescription drug coverage—currently among the most contentious of health care issues in the U.S.? Not in any way we’d consider to be a model!

To restrict supply, the British use a form of price controls, setting for each pharmaceutical company a target profit for all its sales to the NHS. Pharmaceutical firms aren’t permitted to profit more than the government thinks they ought to—a sure way to arrest research and development.

In addition, the British employ measures to reduce demand. The most recent of these is the National Institute for Clinical Excellence (NICE). Established last year, the program exists to evaluate medical technologies, especially new and expensive ones. Although the name implies independence, it is yet another bureaucracy within the NHS.

Proponents say NICE will end the “postcode lottery,” a method used for rationing prescription drugs. To date, it has failed to do so.

The simplest way to describe this nonsensical approach to rationing pharmaceutical drugs is to call it a health care lottery based on a consumer’s zip code. The prize is your eligibility to receive free medication. But the lottery prize is not permanent. The “lucky” postcode can change and seems to be based on political expediency rather than medical necessity.

Imagine living in one postcode and getting life-saving medications free from the NHS. Then imagine being notified the postcode has changed. You no longer qualify for the medication, because the free postcode moved across the street or across town, and you didn’t.

The NHS failed to respond to my repeated requests for information about how the qualifying postcode is selected.