Headline trade and market deals are opening doors to greater patient access

It is easy to focus on the glorious scientific discovery and wondrous innovation that cut waves along the surface of pharma performance; it’s a bit harder to reach into the depths and find transformation in the financial weeds.

A descent into the tendrils of balance sheets, trading matrices and international policy can require the need for decompression before emerging with a clear idea of where and how they influence markets.

But the complex disciplines of pricing, global deals and access thresholds are having their moment in the sun as the biggest catch of the season, with market-shaping changes that are creating significant ripples in 2026.

The confluence of the Voluntary Scheme for Branded Medicines Pricing, Access and Growth (VPAG) dropping from 22.9% to 14.5%, the 2026 Statutory Scheme headline payment being cut from 24.3% to 16.5%, the UK-US tariff and investment deal and the rise of NICE cost-effectiveness thresholds has created a positive climate for investment, innovation and, critically, patient access to therapies.

There are detractors who warn that the UK will be hit with a huge bill when the three-year 0% tariffs on pharmaceutical exports to the US ends, but the incentive to launch innovative medicines and supercharge the mechanics of getting them to patients has been given a rare boost.

“The indicators are strong. We’re already seeing early signs that clients and the wider industry are making some new progress with their technology appraisals, which is good news for patients,” says Lindsey Rosen, Founder and Chief Executive Officer of Accession, a consultancy specialising in value and access for the world’s largest biopharma companies.

“There has been a lot of discussion and hard work involving the Association of British Pharmaceutical Industry (ABPI), pharma companies and the government to get there and it has put industry in a stronger position. Because of that, patients will benefit. These changes offer great impetus to investment and innovation, and the imperative is to make sure they reach patient level.”

The sentiment is backed up by the ABPI, which is celebrating £1.4bn of UK inward investment from 13 major commitments – including £300m from AstraZeneca and £150m from Boehringer Ingelheim – as a direct result of the UK-US accord. The capacity to get a return on that investment has been made easier by NICE raising its thresholds from £25,000 to £35,000 per QALY, bringing it closer in line with other European nations.

These groundbreaking, top-level deals should act like an oil change, enabling the approval and access machinery to run smoothly without grinding delays and malfunctions. Translating intent and investment into patient benefit by energising access down to sub-national level, where budgets and processes are constrained, will be a key metric of their success.

“They are all positive moves and we are expecting them to improve global investment into the UK,” comments Lindsey, whose consultancy majors in subnational access, supporting their clients to open doors to life-changing medicines for patients. “We play in the real-world space between positive NICE technology appraisals and patients getting access to treatment, which is the difficult last mile and is where we want these changes to have real impact.

“Pharma companies are increasingly aware of the challenge and opportunity of subnational access, and they are responding. Patients can be faced with lengthy delays, even after a positive technology appraisal, so this remains a key challenge. There is, however, good momentum building here, with strong examples from across the industry on how the gap between reimbursement and patient access has been resolved, but much more is needed if we are to make a meaningful industry shift.”
The NHS spends £19bn annually on medicines and, thanks to scientific and medical advances, is increasingly being asked to approve innovative – and expensive treatments for rare diseases. The charity Spinal Muscular Atrophy UK believes the changes will encourage R&D investment, attract clinical trials and accelerate the pathways for getting life-changing drugs to patients. Many patient groups are expectant.

Lindsey observes: “Patient access and commercial results go hand-in hand and over the last 18 months we have seen many pharma companies stand up dedicated subnational access head office teams. The function may have been there in some form, but we are seeing a step change with it becoming an integral part of strategic planning.

“It is about investing more time, resources and focus into subnational access strategy. It is moving up the corporate agenda, but it needs prioritising from the top. It needs embedding and, critically, sustaining across the organisation for it to create impact.

“Thankfully, we have witnessed a distinct narrative change recently with the subnational voice being amplified and senior leaders listening to it, which is fantastic news all round.
“We now have the potential to launch more innovative medicines in the UK, but the programmes of work required to make this work within the local healthcare system needs priority, focus and commitment from pharma. Helping build that across complex local pathways, addressing areas of unmet need and making a genuine difference to patients’ lives is what drives us.

“Achieving subnational access can be very complex, getting down into the weeds and making things happen, but the rewards are phenomenal and I think we are now in a golden age where subnational access has been recognised as a critical element of success.”

Lindsey adds: “Creating national policy is, of course, hugely important, but this is a starting point and, as pharma is launching more and more sophisticated and innovative medicines, there is a need to focus on local implementation if these products are to realise their potential. National and local have to work in harmony to make sure the patient actually gains access and benefits.”

“This work can be complex and challenging, but the hard work and commitment is there to match these new opportunities, and with subnational market access now centre stage, I am confident this will bring long-lasting benefit and positive outcomes to industry, healthcare systems and, most importantly, to patients.”

Danny Buckland is a freelance journalist specialising in the pharmaceutical industry