Pharmaceutical industry figures have defended the US-UK drug agreement, arguing that changes to medicine pricing could improve NHS patient access to newer treatments, including drugs for cancer, blood disorders and autoimmune conditions.
The comments follow criticism of the deal after an analysis suggested it could lead to excess deaths in England if higher spending on medicines reduced the resources available for other NHS care. Richard Torbett, chief executive of the Association of the British Pharmaceutical Industry, said that conclusion relied on a disputed modelling approach and incomplete data.
The debate centres on how the NHS decides whether a medicine offers enough benefit for its cost. In England, the National Institute for Health and Care Excellence, known as NICE, assesses many new treatments before they become routinely available. Its decisions can determine whether patients can receive a drug through the NHS, and whether use is limited to particular groups.
A key part of that process is the cost effectiveness threshold, which is used to judge whether the health gains from a treatment justify its cost. Torbett said the threshold had not increased for almost 25 years and that reform had helped medicines reach NHS patients which might otherwise have been delayed or withheld.
According to Torbett, recent pricing changes have enabled access to a range of new medicines over the past three months. He said these included treatments for several cancers, blood disorders and autoimmune diseases. He argued that the NHS had fallen behind comparable European countries in access to new medicines, particularly for cancer and rare conditions.
For patients, the practical importance is that NICE approval can make the difference between a treatment being available routinely on the NHS or being inaccessible except through clinical trials, private care or special funding routes. Delays in approval can mean patients miss the point at which a medicine may offer the greatest benefit.
However, the same system is also designed to protect the wider NHS budget. Money spent on medicines is money that cannot be spent elsewhere unless overall funding increases. This is why drug pricing decisions are closely watched by patient groups, clinicians, economists and taxpayers.
Torbett said no one disputed the need for sustainable funding, but he rejected the idea that a “modest” change in how the NHS values innovation should be framed as a public health threat. He said that approach failed to take account of patients who are already benefiting from newer treatments, or those waiting for them.
Nick Hoile, senior director and chief operating officer for health at MHP Group, also argued that scrutiny of the deal should consider existing inequalities in access. He cited government figures suggesting that for every 100 patients receiving a newly launched medicine in comparable countries during its first year on the market, only 48 receive it in the UK.
Hoile said the agreement was intended to narrow that gap. His argument reflects a long-running concern in parts of the pharmaceutical sector that the UK has been slower than some peer countries in adopting new medicines after regulatory approval.
The disagreement highlights a wider policy question for ministers and the NHS: how to balance faster access to new treatments with the need to maintain funding for other services, including diagnostics, surgery, primary care and long-term condition management.
Patients should not assume that the agreement will automatically make every new medicine available. Access still depends on regulatory approval, clinical evidence, NICE assessment, negotiated pricing and NHS implementation. Some medicines may be approved only for specific patient groups where the evidence of benefit is strongest.
The issue is particularly important for people with cancers, rare diseases and complex immune conditions, where treatment options can be limited and new medicines may offer meaningful benefit for some patients. At the same time, health economists and public bodies are likely to continue examining whether higher medicine spending delivers enough overall health gain for the NHS population.
The next test will be how the reformed arrangements affect NICE decisions and actual prescribing in hospitals and clinics. For patients, the central question is not only whether more medicines are approved, but whether they are made available quickly, fairly and without weakening other parts of NHS care.
