Missing metrics on the UK’s VPAG

Market Access
British pound coins and two yellow and blue pills

Leela Barham tried to take stock of what’s happening operationally with the UK's main pricing scheme, VPAG, but couldn’t, given the absence of reporting by the Department of Health and Social Care for a year.

Is the lack of agreement on wholesale change to the scheme a good enough reason to roll back on operational reporting?

Operational reviews and metrics

As part of the 2024 VPAG, there was an agreement to conduct operational review meetings every six months. The first operational review held in 2024 also committed to agreeing on “success factors and metrics” that would be reviewed every six months thereafter.

The scheme also made it clear that there was “no expectation that any such operational reviews will result in amendment of the 2024 Voluntary Scheme.”

Published metrics

At the core of the scheme are companies paying rebates when the NHS spend on branded medicines goes above a cap. This manages affordability from the government perspective. There are also other commitments in the scheme that deal with access and economic growth.

So, it follows that the metrics touch on all of these:

  • Number of product launches and price applications.
  • Number of NICE technology appraisals published.
  • Type of NICE recommendation.
  • Rolling 12-month mean average (in days) for NICE to publish single technology appraisals (STAs).
  • Scheme membership.
  • Overall sales and sales by scheme, before and after payments (rebates) made.
  • Scheme payments in millions, broken down across the devolved nations of the UK.
  • Exempt sales and sales of small and medium companies, which include sales of new active substances (NAS).
  • Growth gross of payment, which includes the percentage growth rate by quarter, as well as year-to-date growth.
  • Total number of pharmaceutical companies registered on UK PharmaScan.
  • Type of data available on UK Pharmascan registration.
  • Total number of PASs in operation and number of commercial access agreements (CAAs) or managed access agreements (MAAs) in place.
  • Rate of technology appraisal incorporation into clinical guidelines.

The most recent metrics relate to those discussed in the operational review meeting held on 25 November 2024. No metrics are available for 2025.

No agreement from the accelerated scheme review

The 2024 VPAG included provisions for two scheme reviews. The first was originally timetabled for autumn 2025 and the second for spring 2027. The first was brought forward, aiming to report in June, as announced by the ABPI in April 2025. Back then, it was pitched as an opportunity to do the review to coincide with the publication of the government’s 10-year plan for the NHS and the Life Sciences Sector Plan.

Presumably, the lack of both more recent metrics and minutes from operational reviews is because a fast-tracked scheme review held over the summer of 2025 ended without agreement.

Yet, the VPAG is still running. It’s even more important to know about how well it’s going because it either strengthens the case for change – a big uptick in non-submissions to NICE would be a worry, not least to patients who are left somewhat in limbo when that happens – or weakens it.

Benchmarking

How well the VPAG is going, as determined by the metrics, can be added into the mix in the wider context that has led to industry calls for bigger changes.

Whether stakeholders agree or disagree with changes mooted that range from the NHS spending a billion more on medicines to increasing the threshold NICE uses to determine value for money, they are likely to want to have both a benchmark to start from and metrics to determine the impact of those changes.

Maybe there should even be different metrics. Those in place do little to address the issues that the industry has been raising, which rest more on the UK’s lack of international competitiveness.

Companies must decide whether to stay or go by 16 December 2025

On 13 November, companies were given a second extension to decide whether to stay within VPAG or leave and be subject to the statutory scheme. That scheme is set out in law, can be changed by the government with relative ease, as shown by repeated changes to it in recent years. It requires a public consultation and just a little time in parliament. The statutory scheme currently has a higher rebate rate than VPAG.

Change in rebate rates can be expected, though, as the government intends for the statutory scheme to be broadly commercially equivalent. If VPAG rates go up, statutory scheme rebates are likely to follow and vice versa. Adding a billion to NHS spending on branded medicines – if that materialises - would lower rebate rates in both schemes.

The extension to companies to take their decision to stay or leave VPAG was granted, according to the ABPI, to “give companies more time and better information to help them make decisions in the context of ongoing global uncertainty affecting the life sciences sector.”

That global uncertainty is a reference to Trump and the pressure on the ex-US countries to pay more so that the US can pay less for drugs.