What does the latest data tell us about NHS patients' access to medicines?

Medicines are a fundamental tool in the treatment of many diseases. New medicines are constantly being researched and developed with the goal of improving health outcomes. Choosing which medicine to use for any specific patient is a decision for clinicians. However, deciding which medicines NHS prescribers can use depends on a range of complex policy, procurement and regulatory decisions. Different countries take different approaches, and therefore, the medicines that patients have access to can be variable between countries.

Understanding how well the system performs in meeting the NHS’s ambition for patients to have rapid access to effective new medicines is not easy. There are several sources of data, and like any reporting of metrics, it isn’t always immediately obvious what the data includes/excludes.

Using NICE data to understand NHS access to medicines

In England, most new medicines must undergo an appraisal by the National Institute for Health and Care Excellence (NICE) on their clinical and cost-effectiveness before they can be used on the NHS (NICE’s decisions are also adopted in Wales and NI). This makes the data reported by NICE a helpful starting point for our headline question.

The NICE website currently shows that since 2000, 84% [1] of its appraisal recommendations are positive (recommended, optimised or recommended for use in a managed access fund) [2]. This figure is reported for the entire technology appraisal work programme since 2000, so requires further analysis to explore trends. It does not include terminated appraisals though (where a company has not submitted evidence, or the appraisal has been discontinued). 

In the last five years (2019-2024), around a fifth of the NICE work programme has been terminated – a 100% increase since the preceding five-year period [3] - meaning that NHS patients are not able to access those medicines for their condition.

Positive recommendations from NICE also include ‘optimised’ decisions. In such cases, there is a limit on the number of patients that can access the medicine, compared to the range of eligible patients for whom the medicine has been licensed by the Medicines and Healthcare products Regulatory Agency (MHRA).

The reasons behind a decision being optimised by NICE vary and will sometimes be at the discretion of the company but they are usually made because treating the full patient population is not considered by NICE to be a cost-effective use of NHS resources.

A recent report exploring the level of access when NICE recommendations are optimised shows in the last two years, the average level of access has been for under a third of eligible patients, the lowest since 2015 (note data to estimate this is available in approximately half of the optimised recommendations) [4]. There is also a long-term trend of NICE making an increasing proportion of optimised decisions.

Comparing access to medicines across Europe

Comparing access across countries is not straightforward. There can be differences in how patients are treated and the licences for new medicines granted by the relevant regulator. A comprehensive data source is the annual EFPIA Patients W.A.I.T. Indicator report [5]. This compares the availability of new medicines (in their first indication and subsequent indications for orphan medicines – so not a full picture) across Europe. You can read more details on how this report works in our blog from last year.  

The most recent report (published in May 2025) shows England lying sixth in the rankings for availability of new medicines licenced in 2020-2023, an improvement on last year’s report, but remaining in a similar position to previous years.

When considering the level of restricted access though (mainly due to optimised recommendations), England falls to tenth place among its European peers. England lies sixth for time to availability, a position we would expect to see improve in future reports, given NICE’s recent updates on improving timeliness of guidance publication and concerted efforts on this.

Scotland is also reported and ranks twelfth for availability and seventh for time to availability.

The availability of orphan medicines treating patients with rare diseases remains lower for both England and Scotland in comparison to all medicines (52% compared to 65% for England and 44% compared to 57% for Scotland).

Conclusion

The data shows that there is more to do for the UK to be internationally competitive on access to medicines. Ensuring there is a focus on improving breadth of access as well as time to access is important.

With the government’s attention on its plans for the healthcare system and driving a growth agenda for industry, there seems to be no better time to make some bold decisions to ensure metrics reporting on access to medicines all turn in the right direction.

Notes
[1] Correct at the time of writing
[2] Technology appraisal data: appraisal recommendations | Technology appraisal data | Technology appraisal guidance | NICE guidance | Our programmes | What we do | About | NICE
[3] Analysis of NICE reported data
[4] OHE. What is the recommended level of patient access? An analysis of NICE’s optimised decisions from 2015 to 2024. May 2025
[5] EFPIA Patients W.A.I.T Indicator 2024 survey