Pharma chiefs warn NHS underinvestment is denying UK access to life‑saving drugs

Pharmaceutical industry leaders said the National Health Service's approach to drug pricing is leaving patients without access to new cancer medicines and has prompted firms to curb investment and clinical trials in the UK.

AstraZeneca on Friday paused what it described as a planned £200 million investment in a Cambridge research site, days after Merck cancelled a £1 billion expansion in the country. Bristol Myers Squibb said it had cut hundreds of UK jobs, ended drug trials and stopped 34 partnership projects with the NHS because of what its UK head called "chronic underinvestment" in medicines.

Guy Oliver, UK head of Bristol Myers Squibb, told The Times that decisions by companies to withhold investment or not bring medicines and trials to the UK were driven by the economics of operating in a market that he said did not sufficiently value innovation. "There is a human cost to this all. Patients are really suffering, and have been suffering for many, many years now," he said.

Industry bodies pointed to data showing more than 60 medicines were not available in the UK over the past five years and said the country spends about 9% of its health budget on medicines, a lower share than comparable nations. They also noted that the cost-effectiveness threshold used by the National Institute for Health and Care Excellence has not changed in more than 25 years.

Companies have singled out a number of cancer therapies as examples of treatments available in other countries but not routinely available on the NHS. Enhertu, an antibody drug for certain breast cancers, is used in other European health systems and in clinical trials was associated with a doubling of progression‑free survival and a lower risk of death over an 18‑month period compared with standard chemotherapy. The drug is available through Scotland's health service but has been repeatedly declined by NICE for routine NHS use in England.

Other medicines named by the industry in public comments include Trodelvy, a targeted chemotherapy delivery agent for some breast cancer patients, and Reblozyl, which treats anaemia for adults with certain blood disorders.

Pharma executives say another structural problem is the existing voluntary pricing and access agreement — known as VPAG — which requires companies to pay back profits to the NHS if sales exceed a set threshold. They argue the VPAG clawback is significantly higher in the UK than in comparable countries and is a deterrent to bringing new medicines and trials to the market.

"Every day that we don't continue these talks means more and more decisions that companies like BMS have to make around not bringing our clinical trials, not launching a medicine, and not partnering with the NHS," Oliver said.

Negotiations between ministers and the industry over pricing and investment resumed and stalled in recent months. Health Secretary Wes Streeting stepped away from talks in September after a month of discussions, according to industry accounts. Companies are urging a review of NICE thresholds and a renegotiation of VPAG terms to bring them more in line with international standards.

Last week, Eli Lilly said it would raise the wholesale UK price of its weight‑loss drug tirzepatide (marketed as Mounjaro) from September in response to global pricing pressure following public comments from US political leaders. For the highest dose, Lilly has proposed an increase from a list price of about £122 to £330 per dose. Industry leaders have warned that public disputes over pricing between governments and global manufacturers risk creating knock‑on effects for availability and investment decisions.

Johnson & Johnson's UK managing director, Roz Bekker, said delays to reform would hurt the UK's competitiveness and patient outcomes, and that the VPAG clawback was currently "three times higher than comparable countries." Dr Leyla Hannbeck, chief executive of the Independent Pharmacies Association, cautioned that patients should not be used as leverage in wider disputes over drug costs.

A government spokesperson rejected industry claims that the UK was failing patients. The spokesperson said cancer care remained an NHS priority as the health service recovered from what ministers have called years of underinvestment, and pointed to a proposed package they described as a "generous and unprecedented offer" worth about £1 billion over three years as part of a review of cost‑effectiveness thresholds.

The government statement said it would "always stand behind cancer patients and ensure they get access to the best available care and affordable cutting‑edge drugs they need," and that the national cancer plan would set out measures to improve outcomes and restore the NHS's standing in cancer care.

The row highlights tensions between pharmaceutical companies seeking predictable returns on research and development and a public healthcare system that must weigh cost‑effectiveness and budget pressures. Industry representatives argue that a failure to update pricing frameworks and to align clawback mechanisms with other high‑income countries will lead to further reductions in clinical trials, jobs and access to medicines in the UK. Ministers say they have made a financial offer and are balancing affordability with access as part of longer‑term NHS planning.