The UK–US Trade Agreement and the NICE threshold changes do not apply in Jersey or Guernsey, which are not part of the NHS and operate their own prescribing frameworks. While the arrangement does not bind either island, both Jersey and Guernsey procure most medicines through NHS supply chains or NHS framework agreements, meaning any increase in NHS list prices for branded medicines is likely to affect what the islands pay. The Channel Islands have no equivalent to the VPAG rebate mechanism and no independent negotiating capacity with pharmaceutical manufacturers. If the UK-US deal drives up branded medicine prices more broadly, both islands will face the same price increases with no offsetting rebate
