Question to the Department of Health and Social Care:

To ask His Majesty's Government what assessment they have made of the long-term fiscal implications of the updated NHS commercial framework for new medicines.

The update to the NHS Commercial Framework for New Medicines, published in 2025, provided greater detail about the options for enhanced commercial flexibilities for new medicines, and when such flexibilities can be offered. The update did not seek to expand or change the use of these mechanisms but was a technical update to provide improved clarity and to formalise existing arrangements. As such, NHS England does not consider that the update itself would be cost-inflationary for the National Health Service’s medicines budget. NHS England would expect increased costs if these updates help facilitate patient access to a larger number of medicines, but these costs would be incurred from improving patient health. Any additional costs as a result of better patient access will depend on the drugs brought forward for NHS use in the future.

However, the update also included confirmation of an increase to the Budget Impact Test threshold in England, from £20 million to £40 million. The intention to consult on the move to a £40 million threshold formed part of the 2024 voluntary scheme for branded medicines pricing, access and growth (VPAG). The cost of making this threshold increase was considered as part of the overall VPAG package.