OBJECTIVES: To understand the trends and drivers of local decision-making by Clinical Commissioning Groups (CCGs), and how they may vary across localities, therapy areas, and by respective performance against key performance indicators (KPIs). METHODS: The MIMS website was searched to derive an exhaustive list of new pharmacotherapies between April 2013 and April 2015. This list was cross checked against all assessments conducted by the National Institute for Health and Care Excellence (NICE). The products that had been reviewed by NICE were subsequently excluded, given CCGs must implement any recommendation by NICE and hence does not demonstrate local decision making. Secondly, a representative sample of CCGs were selected across the regional locations of North, South, Midlands and East of England, and London (as defined by the NHS England regional team structure). A sample of 20 CCGs were shortlisted and their respective formulary lists analysed to capture their commissioning decisions on the non-Nationally assessed pharmacotherapies. Finally, CCG commissioning decisions on the sample products was correlated against any local key performance indicators or priorities, the CCG Outcome Indicators, and their respective performance against them, to determine any trends and drivers of local decision-making.  RESULTS: As expected, there was variation across CCGs in funding decisions. However, there was only a limited correlation between funding decisions and CCG priorities or performance. It became evident that there were no strong discernible trends or drivers for local funding decisions on these products.   CONCLUSIONS: Unlike the national level assessments undertaken by NICE, the drivers of local formulary decisions on new pharmacotherapies are difficult to establish and vary across CCG, making it difficult for pharmaceutical companies to obtain access for their medicines using a “one size fits all” approach. Thus, pharmaceutical companies need to engage more closely with CCGs to better understand their needs (including beyond-the-pill) and demonstrate the ‘localised’ value of pharmacotherapies.