The political and economic imperative for UK Pharma Market Access 

While the UK pharma market access sector retains world-class research capabilities, globally respected regulatory institutions, and a uniquely integrated healthcare system, it is not a country that is consistently prioritised as a leading launch market for new medicines.

Our roundtable discussion in November explored a central question: What does the UK life sciences sector need to change in order to be prioritised more often as a leading market for new product launches?

The answers from our panel of experts revealed operational complexity, pricing pressures, adoption challenges, rare disease economics, real-world evidence utilisation – but they also pointed to something deeper. The UK’s market access environment is not simply a technical or procedural issue but a matter of national political and economic positioning.

In Part 2 of our series, we build on our original roundtable discussion to explore the political and economic forces shaping market access. We revisit key themes and dive deeper into why the UK must better align pricing, regulation, industrial strategy, and NHS adoption to create a more cohesive, growth-focused framework.

Discovery excellence alone does not guarantee launch prioritisation

It can’t be denied that the UK continues to deliver outstanding science. Our universities, research charities and translational infrastructure are well thought of. Institutions such as the National Institute for Health and Care Research (NIHR) anchor a research ecosystem that many countries seek to emulate.

Our healthcare system, delivered through the NHS, offers the theoretical advantage of scale, integration and longitudinal data capture that fragmented systems struggle to replicate.

Regulatory credibility remains high. Approval from the National Institute for Health and Care Excellence (NICE) still carries weight internationally, even as European coordination through Joint Clinical Assessment evolves. And yet, in global launch sequencing conversations, the UK is increasingly positioned behind the United States and Germany.

This is where we find ourselves in paradox: we have the world-leading discovery but are cautious of commercialisation.

Global pharmaceutical boards consider pricing flexibility, speed of reimbursement, uptake rates, political stability and long-term commercial viability. Where these factors appear constrained, launch sequencing shifts.

If the UK becomes predominantly a discovery engine while commercial value accrues elsewhere, the long-term consequences are significant: fewer trials, reduced inward investment, and diminished global influence.

Pricing Policy is fast becoming a political signal

The debate still surrounding the 2024 Voluntary Scheme for Branded Medicines Pricing and Access (VPAG) illustrates how pricing frameworks act as signals to global markets. From a fiscal perspective, VPAG provides NHS budget predictability. It caps branded medicines spend growth and returns overspend to the system through rebates. In a constrained public finance environment, this is understandably attractive (for the government and the UK taxpayer).

However, from an industrial strategy perspective, rebate levels and pricing rigidity send a message about the UK’s risk appetite and growth ambition. The tension is clear and still leaves us wondering, is medicines expenditure viewed primarily as a cost to be contained, or as an investment in a high-value economic sector?

Germany and the United States frequently tolerate higher upfront pricing in exchange for accelerated launch sequencing, clinical trial activity and associated economic multiplier effects.

The UK’s model emphasises control and predictability. Stability can be valuable, but only if the baseline remains commercially competitive. Future iterations of VPAG will therefore be read not merely as technical adjustments, but as declarations of intent about the UK’s growth orientation.

The case for a joined-up Government remains

One theme echoed strongly through our panel discussion was fragmentation.

In the UK, the healthcare landscape is shaped by a number of key governing bodies, including:
• Department of Health and Social Care
• NHS England
• National Institute for Health and Care Excellence (NICE)
• HM Treasury
• Medicines and Healthcare products Regulatory Agency (MHRA)

Each body fulfils its mandate effectively, yet global competitors are increasingly coordinating better industrial, regulatory and reimbursement policy under a unified growth objective. When regulatory acceleration is not matched by reimbursement efficiency, gains are diluted. When NICE demonstrates methodological flexibility but local NHS adoption lags, value is lost in between the cracks.

When the Treasury negotiates aggressively on price without explicit linkage to inward investment metrics, industrial strategy becomes self-limiting. The UK possesses the institutional architecture required to compete, but what it lacks is full strategic alignment across those institutions.

Periods of political transition can create opportunities for reset. Recognition that the NHS faces structural strain could allow for more radical, growth-oriented thinking, particularly if life sciences is positioned as part of the solution rather than as a cost centre.

Real-World Evidence should be utilised as a strategic asset

If there is one structural advantage the UK continues to hold, it is data. A nationally coordinated healthcare system creates the potential for large-scale, longitudinal real-world data generation. Increasing acceptance of real-world evidence (RWE) in regulatory and HTA contexts presents an opportunity for differentiation.

The UK has already shown openness to innovative methodologies through NICE appraisals and early engagement pathways, and the Accelerated Access Collaborative provides an example of cross-system collaboration designed to speed adoption of breakthrough innovations.

However, generating RWE can be very resource intensive. If companies invest in collecting outcomes data, there must be mechanisms to dynamically use that evidence, including potential reassessment or value-based pricing adjustments. Unfortunately, it seems that without that feedback loop, the strategic advantage looks to remain theoretical.

In a global environment where AI, digital health and data analytics are accelerating, we quickly concluded that the UK could position itself as a testbed for integrated clinical-commercial evidence models. This would reinforce its attractiveness not only as a launch market, but as a lifecycle management partner.

Rare disease innovation exposes the structural limits of traditional health technology assessment models

Cost-per-QALY frameworks were not originally designed for ultra-small populations with high R&D risk and uncertain long-term data. While NICE has introduced flexibility in certain contexts, concerns remain about whether the system appropriately values non-curative or disease-modifying therapies.

If the UK wishes to remain competitive in advanced therapies and rare conditions, it must ensure that assessment models evolve alongside scientific innovation.

Failure to do so risks discouraging precisely the type of cutting-edge development the country seeks to attract.

Policy is shaped by public confidence

Pharmaceutical pricing debates are often framed narrowly around affordability and profit. Less visible are the economic contributions of the life sciences sector, the scale of R&D risk, and the long-term productivity benefits of innovation.

If medicines are consistently portrayed as a budgetary burden, policymakers have limited room to manoeuvre.

We believe that reframing the narrative by positioning life sciences as economic infrastructure and a driver of national resilience is essential. This is not about advocating for unchecked pricing, but about articulating a balanced story of value creation. Plus, political leaders are more likely to pursue growth-oriented reforms when public understanding supports them.

The UK remains at a strategic crossroads

We can continue to operate as a scientifically excellent but commercially cautious market, credible, respected, but rarely prioritised as a commercial first. Or we can align pricing policy, regulatory innovation, industrial strategy and NHS adoption into a coherent growth framework.

Such alignment would require:

• VPAG structures that balance sustainability with competitiveness
• Greater cross-department coordination
• Incentivised use of real-world evidence
• Expansion of collaborative adoption mechanisms
• Explicit recognition by the Treasury of life sciences as a growth engine

Our discussions concluded that the ambition for the UK to become a life sciences and healthcare economic powerhouse is achievable. The infrastructure exists. The talent exists. The credibility exists.

What remains is the political and economic will to connect the pieces. What began as a discussion about market access ultimately becomes a question of national strategy: if the UK wants to be prioritised as a launch market, it must first prioritise itself.

We’d like to again extend our thanks to all participants who joined us for the original discussion:

• Geoff Dobson, CRS Non-Executive Director, Discussion Chair
• Martin Anderson, Founding Director, Carrot Recruitment
• Tarquin Bennett-Coles, Director, Compass Carter Osborne
• Vladimir Babiy, Associate Director Global Health Economics and Outcomes Research, Novartis
• Judit Banhazi, VP Value & Access, Connect HEOR
• Tijana Ignjatovic, Executive Director Global Market Access & Pricing, Genesis Research Group
• David McConkey, Partner, Access Infinity
• Cristina Sarb, Executive Corporate Affairs Lead, Novartis
• Ross Selby, Value, Access & External Affairs Director, ITF Pharma
• Andrew Smith, UK Market Access Manager, Sun Pharma
• Nyree Sweeney, Executive Director Global Market Access, Menarini
• Oliver Jack, Market Access Lead, Independent
• Aodan Tynan, VP, Head of Global Market Access, Astellas
• Jasim Uddin, Market Access Practice Lead, LCP Health Analytics

Looking for expert support in hiring within Market Access, HEOR, and RWE? 

Carrot Recruitment has built a strong and proven track record within the Market Access, HEOR, and Real-World Evidence space. Over the past three years, we’ve delivered consistently across for our valued clients across the life sciences sector. 

The majority of our assignments span the USA, the UK, and Europe with a focus on mid-to-senior level appointments.  

Notably, much of our work is now conducted through exclusive partnerships, enabling us to provide a highly tailored, high-quality service that drives long-term talent retention and business success. 

Martin Anderson

Founding Director