The way in which medicines are valued for NHS use has had a negative effect on UK patient access to medicines and health outcomes
- Before a new medicine can be used in the UK, it must be licenced by the Medicines and Healthcare Products Regulatory Agency (MHRA), the expert organisation used by government to make sure that medicines and healthcare products available in the UK meet safety and effectiveness standards.
- A medicine is also evaluated by the National Institute for Health and Care Effectiveness (NICE), the expert organisation used by the government to assess whether treatments represent value for money for the NHS in England. NICE recommendations are also followed in Wales and Northern Ireland.
- While NICE does an important job, the methods it uses urgently need to change to ensure UK patients can be treated with the medicines they need.
- NICE’s cost effectiveness threshold, used to determine whether a medicine is considered value for money, had remained unchanged at £20000-£30000 for over 20 years, meaning that the amount the UK was willing to pay for new medicines has declined in real terms, given inflation and increases in the NHS’s budget.[1]
- The changes announced on 1 December, including an increase to the baseline threshold used by NICE, should mean that more innovative medicines will reach a greater number of NHS patients.
- While a significant step in the right direction, it is important to note that if the upper end of NICE’s threshold had increased in line with inflation since 1999, it would now be around £56,794.[2] If it had increased in line with the NHS budget growth since just 2014, it would now be £59,150.[3]
- What’s more, between January 2023 and December 2024, 47 per cent of NICE's positive decisions were restricted, meaning that even when NICE did recommend the medicines as cost effective for NHS use, this was only for a subset of the potential patients who could benefit. Where data was available to explore access restrictions, on average, less than a third of eligible patients had access on the NHS.[4]
- An analysis by PhRMA highlighted greater access restrictions faced by patients in the UK compared to the US, Germany and France: only 39 per cent of new medicines launched globally (2017-2021) were recommended by NICE, and only 13 per cent of new medicines recommended provide full coverage for UK patients.[5]
- The UK’s overall medicines availability is in long term decline, in contrast to other EU nations. 28 per cent of total European Medicines Agency (EMA) approved medicines have limited availability in England, and 35 per cent are not available at all. In Germany, 90 per cent have full availability and only 10 per cent are unavailable.[6]
- England has slipped from being the first for granting access to new medicines in Europe to sixth in less than 10 years (2018 vs 2024 data).[7]
- In the last five years (2019-2024), around a fifth of the NICE work programme has been terminated, meaning that medicines have not been submitted or have been withdrawn before the end of the process. This represents a 100 per cent increase since the preceding five-year period.[8] Companies say that challenges in meeting NICE’s stringent cost-effectiveness requirements and lack of commercial flexibilities are key factors behind increased terminations.[9] This rise in terminations does not include medicines that are not brought to the UK at all, neither seeking a licence from the MHRA nor an access decision from NICE.
Even after approval by NICE, variation in the adoption of medicines persists across care settings and geographies, with the UK still lagging other countries
- The NHS is obliged to fund NICE-approved treatments within 90 days of a positive recommendation. Despite this, NHS adoption (usage) can be highly variable across the country and across care settings.
- Adoption levels vary considerably when broken down based on disease area. For example, when comparing the use of three types of medicines related to diabetes, there is more than 51 per cent variance between NHS Trusts in England.[10]
- Across a broader set of NICE-approved medicines, variation in adoption is also extreme. For example, patients in Derby ICS are three times less likely to receive new NICE-approved medicines than those in Norfolk or Surrey.[11]
- Even five years after launch, the average adoption of the newest medicines in the UK among eligible populations is just 62 per cent of the average in comparator countries.[12]
Why does this matter, and what needs to happen?
- Restrictions in access to medicines have a knock-on effect on health outcomes, with the data showing death from treatable and avoidable causes in the UK is the second worst in the G7 after the US, with death from treatable causes half again more than Japan, France and Canada.[13]
The UK needs to invest more and improve how it values medicines if it is serious about improving the health of the population. The agreement announced on 1 December commits the UK to addressing the country’s past decade of underinvestment in medicines and is an important step forward towards ensuring patients can access innovative medicines needed to improve wider NHS health outcomes.
References
[1] OHE. International cost-effectiveness thresholds and modifiers for HTA decision making. 2020. Available at: International Cost-Effectiveness Thresholds and Modifiers for HTA Decision Making - OHE
[2] £30,000 in 2024 prices, base = 1999 adjusted for inflation (GDP inflator, June 2025)
[3] £30,000 increased in line with nominal NHSE to 2025, base = 2014 (ABPI analysis of calendar-year adjusted NHS budget)
[4] OHE. An analysis of NICE’s optimised decisions from 2015 to 2024. Available at: OHE-NICE-Optimised-Decisions-Report_final_2May.pdf
[5] PhRMA. Analysis of Access Restrictions to New Medicines in the United Kingdom. 2023. Available at: Analysis of Access Restrictions to New Medicines in the United Kingdom | PhRMA
[6] EFPIA. Patients W.A.I.T Indicator 2024 Survey. Available at: efpia-patients-wait-indicator-2024-final-110425.pdf
[7] EFPIA. Patients W.A.I.T Indicator 2018 Survey. Available at: EFPIA Patient W.A.I.T. Indicator Study 2018 Results 030419
[8] OHE. Analysis of NICE Terminations. 2024. Data on file.
[9] NICE Public Board meeting paper Sep 2025. Medicines data: NICE approvals and availability in England.
[10] Transforming lives, improving health outcomes | NHS Confederation
[11] IQVIA (2022), analysis for ABPI on Local Uptake of NICE Approved Medicines
[12] ‘Domestic market’, Life sciences competitiveness indicators 2024: summary - GOV.UK
[13] OECD. Health at a Glance. OECD Indicators. Avoidable mortality (preventable and treatable). 2023. Available at: Health at a Glance 2023: Avoidable mortality (preventable and treatable) | OECD