Are NHS patients keeping up with European neighbours on access to new medicines?

Each year, the European Federation of Pharmaceutical Industries and Associations (EFPIA) publishes its annual Patients Waiting to Access Innovative Therapies (W.A.I.T.) report – one of the most comprehensive datasets on the availability of publicly funded new medicines across Europe.

What the data shows
The report covers medicines approved by the European Medicines Agency (EMA) between 2021 and 2024, tracking availability and speed of access for patients in national health systems.

England ranks 7th out of 36 European countries - around 61% of EMA-approved medicines have been approved by the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) and are recommended by the National Institute for Health and Care Excellence (NICE) for NHS use in England. Scotland ranks 11th (53%). Among those countries most like the UK in terms of population and economy (France, Germany, Italy, Spain), England ranks 4th, behind Germany, Italy and Spain.

When considering medicines available only to a restricted patient group – known as an “optimised” NICE recommendation, a growing feature of approvals – England falls to 10th, with just 33% of medicines licenced during these four years available on a full, unrestricted basis in line with their regulatory licence. Scotland drops to 13th.

Some UK patients either cannot access a new medicine at all, or only if they meet criteria that exclude many for whom it is licensed.

Cancer and rare disease patients face the biggest gaps
The data is especially stark for two groups: cancer patients and those with rare diseases.

For cancer medicines, England ranks 14th, with 59% new medicines available to NHS patients. Scotland ranks 19th (48%). Many of these patients are waiting for treatments that could extend or save their lives.

For orphan medicines – developed for rare diseases with few treatment options – England ranks 11th (50%) and Scotland 13th (47%). For these patients, access to a single medicine can often mean the difference between having a treatment option and having none.

These gaps are among the reasons the UK needs to better reflect the value of medicines for patients with few or no alternatives.

There is some better news on speed of access decisions
Reducing delays to access decisions is a government priority, and there is improvement: medicines are being approved for use on the NHS faster than in the previous data set. From MHRA approval to access decision, England has risen to 5th (332 days) and Scotland to 6th (347 days) [1]. However, timelines still lag pre-2024 levels, so further progress is needed to restore previous performance. 

The UK’s declining rate of availability arises from challenges at many different points in the approval process before medicines reach patients 

The UK’s declining availability reflects several factors in an increasingly complex global regulatory and commercial environment. The first step to a medicine access decision is regulatory licensing - in the U.S. this is done by the Food and Drug Administration (FDA), in the EU the EMA, and in the UK the MHRA. 

The ABPI’s analysis of EFPIA’s new Regulatory Indicator shows that around one-third of US-licensed medicines are not licensed in Europe or the UK. This reinforces the concern that UK patients are missing out on medicines available elsewhere. 

Why this matters now and what is changing
The government has recently taken important steps to address these issues. The UK-U.S. pharmaceutical arrangement included commitments to improve the commercial environment to support access to new medicines. Recent changes to the NICE baseline threshold – the benchmark determining value for money – is an important first step to bring more medicines to NHS patients.

Work to better align NICE and MHRA processes is also underway, with the aim of reducing unnecessary delays between a medicine being approved as safe and effective and its availability on the NHS.

These changes reflect a genuine government understanding that the UK’s position as a destination for innovative medicines and its attractiveness to R&D investors depend on patients' ability to access them.

What we need to see next
The EFPIA W.A.I.T. and Regulatory Indicator reports benchmark UK patient access against other countries. Behind every percentage point is a real person who can or cannot access a treatment that might save or improve their life. The 2026 report is a reminder that, while progress is being made, a significant gap remains between where the UK is and where it needs to be.

We will continue to work with government, NICE, the MHRA, and the NHS to ensure that the evolving policy landscape translates into real improvements for patients – and, we hope, that future editions of these reports will reflect this.

[1] Rankings using the mean time to availability and inclusive of all countries, with local authorisation dates where relevant (including MHRA licensing dates for England and Scotland). Two countries lying above England and Scotland have a small number of medicine approvals (Macedonia and Serbia). Median time to availability is also presented in the report with England ranked 7th and Scotland 9th (or 5th and 6th respectively when countries with a small number of medicine approvals – Malta, Serbia and Macedonia – are excluded).