Presentation (CTI)

OBJECTIVES: U.S. pricing and trade developments, including revival of a Most Favored Nation (MFN) model and new import tariffs, are expected to narrow U.S.-ex-U.S. price differentials. This may prompt manufacturers to increase ex-U.S. prices to offset reduced U.S. revenues or reconsider launches in some markets to avoid lowering the MFN reference price. Concurrent UK reforms, including the UK-U.S. zero-tariff agreement, the Voluntary Scheme for Branded Medicines Pricing, Access and Growth (VPAG), and NICE’s 2026 uplift of standard cost-effectiveness thresholds (£25,000-£35,000/QALY), are changing the UK branded medicines landscape. This study examines how these reforms may enhance the UK’s capacity to absorb MFN-related global price pressures.
METHODS: A review of MFN policy analyses, VPAG reforms, and NICE methods updates was conducted, supplemented by modelling of a hypothetical NICE appraisal with a base-case ICER of £28,000/QALY, close to the historic (pre-April 2026) acceptability threshold. MFN-related UK price increases of 10%, 20%, and 25% were applied, assuming proportional ICER changes, and assessed against historic (£20,000-£30,000) and revised (£25,000-£35,000) NICE thresholds.
RESULTS: MFN-induced UK price increases of 10-25% raise the ICER from £28,000 to £30,800-35,000/QALY, exceeding the historic threshold. Under the revised threshold, ICERs resulting from 10-25% price increases remain within or at the new upper threshold of £35,000. The fiscal headroom created through VPAG, and the stability offered by the UK-U.S. zero-tariff agreement further support sustained access despite external repricing forces.
CONCLUSIONS: While MFN-induced price shifts pose risks to ex-U.S. markets, recent UK reforms (threshold uplift, VPAG, and tariff stability) collectively strengthen the UK’s structural ability to absorb global pricing pressure without compromising access to innovative medicines. These reforms reposition the UK as a comparatively MFN-resilient market, capable of accommodating global price realignment through a combination of HTA flexibility, fiscal buffering, and trade insulation.