Patients with hepatitis C in England are caught between inflated drug prices and NHS back-door rationing, it was alleged today.
One study shows how NHS officials have "obstructed" the introduction of drugs approved as effective.
A second report, also in The BMJ, sets out how drug companies end up charging "inflated" prices for these drugs.
The allegations were made as campaigners marked World Hepatitis Day today.
Speaking to the journal Dr Andrew Ustianowski, consultant in infectious diseases at the Pennine Hospitals NHS Trust, told how he resigned from an NHS England clinical advisory group in protest at delaying tactics.
Dr Ustianowski said: “I think some people in NHS England would love to clip NICE’s wings and turn it into a kind of recommendatory rather than mandatory body. And if you are going to choose a fight then choosing this battlefield is quite a sensible thing to do – a marginalised population, very high-cost drugs.”
The journal says NHS England tried to persuade the National Institute for Health and Clinical Excellence to change its rules on the implementation of guidance – asking for six months rather than three months.
The drugs in question, Sovaldi and Harvoni, offer cure rates of more than 90%, the journal says. But prices start from £35,000 a patient.
The journal says use of the drugs has now been restricted and clinical teams have been given prescribing quotas.
NHS England could face legal action over the restrictions from the Hepatitis C Trust, it emerged.
The organisation says the price of the drugs has been a key factor in its decisions.
It said it was “exploring the potential for a longer term strategic procurement for a supply agreement with the industry to improve the affordability of and access to treatment further."
The study of pharmaceutical companies by researchers at Cambridge University accuses them of setting prices according to "how much health systems could bear."
This led to them earning billions of dollars in profits, according to Professor Lawrence King and Victor Roy.
They say that by early 2016, one company Gilead had earned more than 35 billion dollars in revenue from hepatitis C medicines in a little over two years.
The highlight several instances of drug companies buying start-up companies developing drugs that could compete with their own.
Professor King said: "The treatments for Hepatitis C may portend a future of expensive therapies for Alzheimer’s to many cancers to HIV/AIDS. Health systems and patients could face growing financial challenges."
A pill too hard to swallow: how the NHS is limiting access to high priced drugs. Analysis: Betting on hepatitis C: how financial speculation in drug development influences access to medicines BMJ 28 July 2016 [abstract]
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