Two of the world's largest pharmaceutical companies are threatening to take legal action against's the NHS in north Cumbria.

It is over a decision to offer patients with a serious eye condition a cheaper alternative drug than the ones they produce.

NHS North Cumbria Clinical Commissioning Group is among a group of 12 CCGs in north east to adopt the new policy for treating those with wet age-related macular degeneration (wet AMD).

They say that prescribing the cheaper drug Avastin could save the region’s NHS up to £13.5m a year within the next five years - enough to pay for an extra 270 nurses or 266 heart transplants

But pharmaceutical giants Bayer and Novartis are threatening legal action, claiming it would breach a patient’s legal right to an approved drug and it is therefore necessary to challenge the decision.

The issue is around the licensing of the drugs.

Novartis's Lucentis drug (ranibizumab) and Bayer's Eylea (aflibercept) are both licensed to treat wet AMD - a leading cause of blindness among older patients.

The alternative drug, Avastin (bevacizumab), is not licensed for wet AMD, so can't be marketed as such.

But the CCG's say several publicly funded trials have shown that it is as safe and effective as the other two - and it is also a tenth of the cost of both of the alternatives.

The CCGs stress that patients will have the ultimate choice, though the potential cost-saving will also be explained to them.

Dr David Hambleton, a former consultant geriatrician and lead on behalf of the North East and North Cumbria CCG Forum, has accused the drug companies of "holding the NHS to ransom".

“There is a mountain of evidence internationally showing that Avastin is safe and clinically effective for wet AMD," he explained.

"We want patients to have the chance to discuss their options with their doctor and make their own choice. If a patient chooses to be treated with Eylea or Lucentis instead, the NHS will respect that choice."

But he said that the two pharmaceutical companies are seeking to stop Avastin being offered, forcing the CCGs to use their drugs.

"Sadly, Novartis, who hold the European rights for Lucentis, and Bayer, who manufacture Eylea, are now attempting to take legal proceedings to force the NHS in the region to use their more expensive drugs.

“We have taken specialist legal advice, and we are confident that we are acting lawfully - in the same way that providers of Avastin to private wet AMD patients are acting lawfully," explained Dr Hambleton.

"Our legal position is strongly supported by a preliminary decision of the European Court handed down in September. That is why we have responded robustly to Bayer and Novartis who have threatened a judicial review in an attempt to deny NHS patients this choice."

But spokespeople for both Bayer and Novartis have told the British Medical Journal that using unlicensed medicines instead of a licensed NICE approved option undermines the regulatory framework and NHS constitution. “Bayer feels it has to act to challenge the decision taken by these CCGs,” a Bayer spokesperson said.

But Dr Hambleton said: “It is right to offer our patients this choice, because the beneficiaries will be their friends, neighbours and family members across our region. We have no interest in legal disputes, but we cannot allow the NHS to be held to ransom."