Intended for healthcare professionals


How a US-UK trade agreement could affect NHS drug prices

BMJ 2020; 369 doi: (Published 01 June 2020) Cite this as: BMJ 2020;369:m1332
  1. Dzintars Gotham, independent researcher1,
  2. Melissa J Barber, PhD candidate2,
  3. Andrew M Hill, senior visiting research fellow3
  1. 1London, UK
  2. 2Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
  3. 3Department of Translational Medicine, University of Liverpool, Liverpool, UK
  1. Correspondence to: A M Hill

Dzintars Gotham, Melissa Barber, and Andrew Hill set out some of the risks to NHS finances

The governments of the UK and US are working on the outlines of a trade agreement.1 Health has emerged as an early focus of public debate on the putative trade agreement, with many concerned that this may facilitate the privatisation of the National Health Service. Although the government has repeatedly stated that the price the NHS pays for drugs “is not on the table,”23 negotiations often involve concessions, and nothing is certain until drafts of the trade agreement can be scrutinised. Provisions affecting prices of originator pharmaceuticals—those protected by patent—are common in trade agreements. Numerous previous analyses have described the substantial effects trade agreements can have on drug expenditure.456789

At the same time, the Trump administration has directed the Office of the US Trade Representative to leverage trade agreements to target alleged “foreign free-riding”—in effect, pushing for trading partners to pay more for originator medicines.10

We do not know when or whether any draft text will be released to the public. In the recent Transatlantic Trade and Investment Partnership (TTIP) negotiations between the US and EU, which eventually fell apart, negotiating texts were not publicly available, and only became available to elected representatives after substantial public outrage.11

Nevertheless, we highlight key areas that could affect the NHS drug costs based on existing trade agreements the US holds with other countries and priorities that the US pharmaceutical industry lobby has set out to the US Trade Representative.12 Areas of concern that should be scrutinised include provisions affecting cost effectiveness protections, investor-state dispute settlement, and provisions relevant to intellectual property. The NHS Confederation and others have also highlighted these concerns.1314

Limiting the role of NICE

The National …

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