UK–US Trade Agreement and July Developments
On 2 July 2026, the Department of Health announced a series of fast-track drug access pilots from September 2026. 1
These pilots add to the cost pressures brought about by the NICE cost-effectiveness threshold increase to £25,000–£35,000 per QALY which took effect in April 2026, and the commitment under the UK–US pharmaceutical arrangement to double branded new medicines spending from 0.3% to 0.6% of GDP by 2036. Nine additional medicines have already been approved for NHS patients in England and Wales since the threshold change. The government confirmed in Parliament that two of the nine were medicines specifically enabled by the new threshold: a brain cancer drug for patients as young as 12 and a last-resort treatment for a rare form of stomach cancer. 1 5
The government confirmed the 2026 VPAG payment rate for newer medicines is 14.5%, down from 22.9% in 2025. This adds to net drug costs to the NHS. 2 3
On 2 July 2026, the British Medical Journal published an analysis (doi: 10.1136/bmj-2026-340588) estimating the US-UK trade agreement will cost the NHS in England an extra £44.7bn by 2036. Their modelling projects 229,000 excess preventable deaths by 2036 arising from the diversion of funding from other NHS services. This number far exceeds the number attributed to Covid between March 2020 and June 2022. The DHSC has rejected the figures and claims the amount will be only £1 billion in the period to 2028/29. As these changes are likely to have a cumulative effect, like a runaway train gathering speed, the claims may not be incompatible. 4
NICE TA — Aficamten (Myqorzo®) for Hypertrophic Cardiomyopathy
NICE issued positive guidance on 30 July 2026 recommending aficamten (Myqorzo®) for adults with symptomatic obstructive hypertrophic cardiomyopathy. The decision was made via NICE’s cost-comparison process, with the manufacturer required to demonstrate cost comparability with mavacamten (Camzyos®), already available on the NHS. Approximately 6,600 patients in England are expected to be eligible. 6
NHS England Commissioning Policy — Fampridine for Multiple Sclerosis
NHS England published a clinical commissioning policy for prolonged-release fampridine on 16 July 2026, making it routinely available from 23 July for adults with MS and associated walking impairment. Approximately 5,000 patients are expected to benefit in the first year. 7
Fampridine had previously been rejected by NICE in 2022 as not cost-effective at the branded price. The decision to commission it was made through NHS England’s Clinical Priorities Advisory Group (CPAG) rather than the standard NICE technology appraisal route. The UK patent on branded Fampyra expired in July 2026, making generic versions available and reducing cost. Scotland, Wales and Northern Ireland had already made fampridine available. 8
Blueteq comment: July 2026 is very significant for high cost drug governance. The fast-track pilots mean that the volume of high cost medicines entering the NHS will further accelerate from September 2026. The BMJ analysis, despite being contested, has put NHS opportunity cost and financial governance before the public. For ICBs absorbing specialised commissioning functions from NHS England under the Health Bill, the combination of more medicines, more routes to market, and likely greater public scrutiny of cost makes the Blueteq HCD system’s audit and invoice-reconciliation capability more relevant than before.
References
1. NHS patients get faster access to medicines under new pilots. GOV.UK / DHSC. 2 July 2026. https://www.gov.uk/government/news/nhs-patients-get-faster-access-to-medicines-under-new-pilots
2. Health costs of the UK-US trade deal on pharmaceuticals (doi: 10.1136/bmj-2026-340588). The BMJ. 1 July 2026. https://doi.org/10.1136/bmj-2026-340588
3. VPAG payment rate for newer medicines will be 14.5% in 2026. ABPI. December 2025. https://www.abpi.org.uk/media/news/2025/december/vpag-payment-rate-for-newer-medicines-will-be-145-in-2026/
4. What is the UK–US pharmaceuticals deal? (including government £1bn estimate and BMJ comparison). House of Commons Library. July 2026. https://commonslibrary.parliament.uk/research-briefings/cbp-10850/
5. UK-US Arrangement on Pharmaceuticals Pricing and Tariffs — written statement confirming two medicines enabled by new NICE threshold. Hansard / UK Parliament. 13 April 2026. https://hansard.parliament.uk/commons/2026-04-13/debates/26041332000022/UK-USArrangementOnPharmaceuticalsPricingAndTariffs
6. NICE recommends heart drug aficamten with simultaneous MHRA approval. The Pharmaceutical Journal. 30 July 2026. https://pharmaceutical-journal.com/article/news/nice-recommends-heart-drug-aficamten-alongside-regulatory-approval
7. Clinical commissioning policy: Prolonged-released (PR) fampridine as a treatment of adults with multiple sclerosis and associated walking impairment. NHS England. 16 July 2026. https://www.england.nhs.uk/publication/clinical-commissioning-policy-prolonged-released-pr-fampridine-as-a-treatment-of-adults-with-multiple-sclerosis-and-associated-walking-impairment/
8. People with MS in England to be given fampridine as patent expires. The Pharmaceutical Journal. 23 July 2026. https://pharmaceutical-journal.com/article/news/people-with-ms-in-england-to-be-given-fampridine-as-patent-expires
