UK government conceals full cost of drug pricing deal struck with Trump administration

The British government is refusing to disclose how much a pharmaceutical pricing agreement struck with Donald Trump will cost the National Health Service (NHS).

A letter obtained by Politico and sent by the Information Commissioner’s Office (ICO) to the Nuffield Trust, an independent healthcare think tank, reveals that the Department of Health and Social Care (DHSC) accepted that releasing its impact assessment was “in the public interest,” given the “potential impacts on NHS spending.”

However, the department argued that releasing this information would “prejudice ongoing policy development, international relations, and commercial interests.”

As part of the agreement signed in December, the UK committed to doubling its spending on new medicines as a proportion of its gross domestic product in exchange for three years of tariff-free access to the US pharmaceutical market.

The deal included a 25% increase in the National Institute for Health and Care Excellence’s (NICE) annual cost threshold.

This has resulted in the NHS paying more for certain new medicines.

Reviewing the DHSC’s refusal to publish the assessment, the ICO sided with the Health Ministry, agreeing that keeping the cost information confidential better served the interests of taxpayers.

A DHSC spokesperson said:

“This government has made clear that the UK-US pharmaceutical pricing agreement will cost around £1 billion over the current Spending Review period, and that this cost will be met through the record settlement agreed for the Department of Health and Social Care.”

In its letter, the ICO stated that “key aspects of implementation are still under active consideration… meaning any impact assessment may well change as policy development progresses.”

The ICO disclosed that ongoing discussions extend beyond pharmaceutical pricing and rebate arrangements.

Officials are still negotiating how the deal will interact with the Trump administration’s forthcoming most-favored-nation (MFN) drug pricing policy.

The UK believed it had secured an exemption from the MFN policy, under which the US will match the prices of a basket of wealthy nations.

Pharmaceutical companies have warned that rather than accepting lower prices in the US, they could delay the launch of new medicines in those countries.

Diarmaid McDonald, executive director of Just Treatment, a campaign group for medicine access, said: “By the very nature of these deals with the White House, the goalposts keep moving, and it is deeply concerning that there are differences between the US and the UK over the interpretation of what has been agreed.”

According to an analysis published by the British Medical Journal (BMJ), some economists estimate that the agreement could lead to up to £45 billion being diverted from existing NHS services to fund additional pharmaceutical spending.

“DHSC argued that disclosure would undermine the safe space needed for ministers and officials to probe assumptions, test scenarios, and refine policy options while relevant discussions are ongoing,” the ICO said.

Sally Gainsbury, a policy analyst at the Nuffield Trust, said: “The risk to the NHS and the cost to public health in this deal are now indisputable. This is a very compelling reason for the public, through our elected MPs, to be able to scrutinize whether this deal aligns with the government’s assumptions regarding broader economic benefits.”

“The fact that this is an agreement we can walk away from makes it even more important,” Gainsbury added, noting that either party could withdraw from the deal with six months’ notice.

Figures across the health sector hope that the new administration led by Andy Burnham will scrutinize the deal, particularly given the prime minister’s emphasis on devolution.

“He [Burnham] said he wants to see good growth in every postcode,” Gainsbury of the Nuffield Trust said. “Can a deal that imposes such heavy costs on population health and on what the NHS can deliver to patients be considered good growth? That is my question to Andy Burnham.”

McDonald of Just Treatment argued that devolved administrations had been excluded from the negotiations:

“Nobody in the Scottish government, the Welsh government, or at Stormont in Belfast knows the details of this deal, even though their health systems will be directly affected by its outcome. Therefore, if Andy Burnham stands by his word, he must commit to opening up this negotiation process and transferring all agreed details to these devolved administrations, shifting power away from this tightly guarded negotiation in Westminster.”