As we regularly refer to how the NHS decides what medications to fund, I thought it worthwhile to describe how drug funding works in the UK. It is pretty complicated so at the lowest level of detail I would summarise as follows.
In the UK, drug funding depends onĀ where and how the treatment is prescribedāthrough the NHS, private healthcare, or research programs. Here’s how different types of drugs, including biologics for severe asthma, are funded:
In the UK, drug funding depends onĀ where and how the treatment is prescribedāthrough the NHS, private healthcare, or research programs. Here’s how different types of drugs, including biologics for severe asthma, are funded:
1. NHS Funding (Primary & Secondary Care)
Most medicines are funded through theĀ NHS, but how they are approved and prescribed varies:
a) NICE & SMC Approval (England & Scotland)
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TheĀ National Institute for Health and Care Excellence (NICE)Ā assesses whether a drug isĀ cost-effectiveĀ for NHS use in England and Wales.
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In Scotland, theĀ Scottish Medicines Consortium (SMC)Ā performs a similar role.
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If approved, the drug isĀ added to NHS formularies, meaning it can be prescribed and funded.
b) Individual Funding Requests (IFRs)
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If a drugĀ is not routinely funded, a clinician can apply forĀ Individual Funding Requests (IFRs)Ā to request NHS coverage in special cases. These funding requests are made to your local NHS Integrated Care Board (ICB) (England – other UK countries have their own systems) who are responsible for managing drug costs
c) High-Cost Drugs & Specialist Prescribing
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Some biologics (e.g.,Ā Benralizumab, Mepolizumab, Tezepelumab) are classified asĀ high-cost drugsĀ and can only be prescribed inĀ specialist NHS clinics, such as severe asthma centres.
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NHS England funds these underĀ commissioned services, separate from standard GP prescribing.
2. Prescription Charges in England
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InĀ England, most adults payĀ Ā£9.65 per prescription itemĀ (2024 rate).
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However, many patients qualify forĀ free prescriptionsĀ (e.g., those with long-term conditions, low income, or exemptions).
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Prepayment Certificates (PPCs)Ā allow unlimited prescriptions for a fixed cost.
Ā Scotland, Wales, and Northern IrelandĀ offerĀ free prescriptionsĀ to all residents.3. Private Prescriptions & Insurance
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Private healthcareĀ patients must pay theĀ full cost of their medicationĀ unless covered by private insurance.
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Some private insurers (like Bupa, AXA, or Vitality)Ā partially or fully coverĀ biologics if deemed medically necessary.
4. Clinical Trials & Early Access
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SomeĀ new biologicsĀ not yet NHS-approved can be accessed throughĀ clinical trials.
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TheĀ Early Access to Medicines Scheme (EAMS)Ā allows patients with severe conditions to access promising new treatments before full approval.
5. Hospital Funding (Secondary Care)
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Some high-cost drugs areĀ funded directly by NHS England or hospital trustsĀ rather than standard NHS prescription budgets.
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These include biologics that must beĀ administered in hospital settingsĀ (e.g.,Ā Reslizumab).
Summary
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NICE/SMC decides which drugs get NHS funding.
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Some biologics require specialist clinics.
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Prescriptions are free in Scotland/Wales/NI but cost Ā£9.65 per item in England.
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Private prescriptions & insurance are alternatives for non-NHS-funded treatments.
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Clinical trials or EAMS may offer early access to new drugs.
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