How evil of the Americans this is
High dudgeon, even cries of vileness at The Guardian:
In December, Starmer and Donald Trump struck a deal on medicine. Downing Street agreed it would spend more on branded drugs, in return for the White House not jacking up tariffs on British pharmaceutical exports to the US. As I wrote at the time, the treaty stank. One of the greatest achievements of British democracy, our NHS, set up to save lives, had been used to save face with Trump. The most rapacious president in American history now had his hands on our healthcare system.
Aditya is really very vexed about it all. There’s even a piece in the BMJ explaining what is to happen:
The National Institute for Health and Care Excellence (NICE) evaluates whether new medicines provide sufficient health benefit relative to their cost. NICE generally assesses this using quality adjusted life years (QALYs), which combine gains in survival and quality of life into a single measure. Historically, NICE has operated with cost effectiveness thresholds of around £20 000-£30 000 per QALY gained. This means that the NHS has generally been willing to pay within this range for one additional year of life in full health, although this threshold can be - and often is - breached in exceptional circumstances, such as drugs to treat cancer.3 These thresholds exist because of opportunity cost and represent an attempt to balance the health gains garnered by new medicines against the health likely to be lost elsewhere in the system when resources are displaced.
In March 2026 ministers took powers to instruct NICE to increase the thresholds they use to judge cost effectiveness.4 From April 2026, instead of paying £20 000-£30 000 for every additional QALY gained by using a new medicine, the NHS will now pay £25 000-£35 000 for the same health benefits.
Given that we’ve had, close enough, 100% inflation since that QALY number was set that means the amount the NHS is willing to spend upon drugs to cure us has halved. Updating that number hardly seems like the most terrible of impositions.
Another mechanism by which NHS drug expenditure is controlled is the voluntary scheme for branded medicines pricing, access, and growth (VPAG). This agreement between the pharmaceutical industry and the UK government is designed to limit growth in NHS expenditure on branded medicines through industry rebate payments when spending exceeds agreed targets. The rate of increase in the prices of new medicines is linked to the amount repaid to the NHS by drug companies, discouraging price inflation. In 2025 the rebate rate was 23%; under the new agreement this has been cut to 14.5%.
This was always going to happen - companies were becoming unwilling to supply the NHS on those extant terms. For yes, you can indeed try to set prices but a shortage of supply is a wholly forseeable possible consequence. And one which we were seeing.
And this is about it in fact. This is what is causing all that hyperventilating.
Our NHS rations our treatment by price. The Americans have forced a reconsideration of that price - upwards. How naughty Trump is to have forced the NHS to pay more of our own money to treat us, eh?
Tim Worstall