MPs seek probe into UK-US pharma deal's impact on NHS

The chairs of six UK parliamentary committees have asked the National Audit Office (NAO) to investigate the UK-US pharma agreement and gauge its impact on public expenditure.

In a joint letter to Gareth Davies, the NAO's Comptroller and Auditor General, the committee chairs – including Health and Social Care Committee chair Layla Moran – said multiple requests have been made to publish the Impact Assessment on the deal to "enable parliamentary scrutiny," with no response.

The government has argued that releasing the document could "prejudice ongoing policy development, international relations, and commercial interests," according to a Politico report, which also notes that the Nuffield Trust think tank has launched an appeal to try to force publication.

The bilateral agreement is designed to ensure that tariffs on medicines imported into the US from the UK would remain at 0% but, as a quid pro quo, the government agreed to increase the net prices the NHS pays for new medicines by 25%.

That increase is tied to changes to the current commissioning framework overseen by the health technology assessment (HTA) agency NICE in England, with an increase in its baseline cost-effectiveness threshold from £20,000-£30,000 – the level used for more than 20 years – to £25,000-£35,000.

Those threshold changes, which came into effect in April of this year, have resulted in some drugs that had patient access held up by cost-effectiveness issues now becoming available; notably, AstraZeneca and Daiichi Sankyo's Enhertu (trastuzumab deruxtecan), which was cleared for use in HER2-low breast cancer this week after a two-year delay.

"While the government has estimated that the agreement will have an impact of approximately £1 billion over the current Spending Review period, it has not published any assessment of the total cost beyond that timeframe," wrote the chairs in the letter.

"Without a comprehensive Impact Assessment covering future years, Parliament and the public are unable to fully understand the long-term implications of the agreement for NHS budgets and wider public expenditure," they added.

The letter has also been signed by the chairs of the Science, Innovation and Technology Committee (Dame Chi Onwurah), Business and Trade Committee (Liam Byrne), Northern Ireland Affairs Committee (Tonia Antoniazzi), Scottish Affairs Committee (Patricia Ferguson), and Welsh Affairs Committee (Ruth Jones).

Earlier this year, Nuffield Trust senior policy analyst Sally Gainsbury said that the deal was "weakening [NHS] cost control and efficiency measures," adding that "the health benefit the population as a whole gets from spending on new branded medicines is only half what it would get if the same spending was used to extend existing services such as GP care or operations from the waiting list."

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