Medicine and Science from The BMJ The US UK trade deal will cost the NHS billions, and only serve to increase pharma profits
May 1, 2026
Sally Gainsbury, senior policy analyst at Nuffield Trust, and Karl Claxton, health economics professor at University of York, unpack the US–UK medicines trade deal. They discuss how the deal forces big NHS drug spending rises. They explain changes to NICE thresholds, rebates, and how costs may be shifted from services to pharmaceuticals.
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Deal Forces Major NHS Drug Spending Rise
- The US–UK deal will double NHS spending on new medicines to 0.6% of GDP by 2036, adding about £52.5bn in England alone.
- Karl Claxton explains targets include 0.35% GDP by 2028 and 0.4% by 2030, plus mechanisms to force expenditure up.
Three Mechanisms Will Drive Up Drug Prices
- The deal uses three mechanisms to raise drug spend: a higher NICE threshold, changed quality-of-life assessment, and adjustable NHS rebates.
- Claxton warns the rebate will be 'dialed up and down' to ensure targets are met.
Higher NICE Threshold Mainly Boosts Drug Prices
- Raising the NICE cost-effectiveness threshold mainly increases prices for drugs already approved and allows a few more marginal approvals.
- Karl Claxton notes manufacturers will raise list prices and reduce commercial discounts once threshold rises.