OBJECTIVES: Access to drugs, particularly high cost oncology medicines, across England has frequently been accused to operate under a ‘postcode lottery’ where access varied depending on where you live. Since 2012, the National Institute of Health and Care Excellence (NICE) recommendations are mandated to be followed nationally within 90 days of issuing. Nevertheless, further regional/local restrictions upon usage are not uncommon that, along with the duration of NICE decision-making and non-universal coverage of medicines by NICE, leads to variability in prescribing levels of high cost medicines. Furthermore, NHS commissioning of specialised services is moving towards increasing co-commissioning between the local Clinical Commissioning Group (CCG) teams and regional/local NHS England bodies (formally Area Teams), with diverse models of care and service specifications being set out as part of the NHS 5 Year Forward View. This research aims to evaluate the level of regional variation in NHS prescribing. METHODS: All cancer drug prescribing data from the most recent NHS innovation scorecard heat map (July-September 2014) was extracted. Variations in prescribing across the 25 Area Teams per 100,000 population were identified. RESULTS: Data for three oncology drugs was available: denosumab, imatinib and nilotinib; NICE has issued positive guidance for all of these. Stark variations in amount prescribed between different area teams were apparent. Nilotinib, highest: Merseyside (220,385mg); lowest: Cheshire, Warrington and Wiral (12,091mg) –18.2 fold difference. Imatinib, highest: East Anglia (370,461mg); lowest: Leicestershire and Lincolnshire (71,592mg) –5.2 fold difference. Denosumab, highest: Cheshire, Warrington and Wiral (11,281DDD); lowest: Merseyside (0DDD). CONCLUSIONS: There are large variations in local prescribing between different NICE-approved oncology drugs, which exceeds what might have been expected from variations in local demographics. The ongoing fragmentation of the NHS particularly with respect to specialised service provision will likely further exacerbate this geographical variability in coverage and potentially fuel a greater ‘postcode lottery.’