Around £45 billion in NHS funding will be diverted from other NHS care by 2036 to pay more for new medicines under the new UK-US trade deal, suggests an analysis published by The BMJ.
According to the researchers, reduced NHS spending on other health interventions would have an adverse impact on public health, increasing excess preventable deaths by 229,000 by 2036. If the indirect effect on adult social care is also included, excess deaths could increase to 291,000. Most of these deaths are expected to be people with cardiovascular, respiratory, gastrointestinal disease and cancer.
The UK-US pharmaceuticals deal was announced by the UK government on Dec. 1, 2025, and described as a “landmark” deal that would “safeguard medicines access and drive vital investment for UK patients and businesses” through strengthening UK-US cooperation in sectors like life sciences and pharmaceuticals.
The agreement secured a 0% tariff on UK pharmaceutical and medical device exports to the U.S. for three years but also committed the NHS to substantially higher expenditure on new branded medicines over the next decade through changes to drug pricing arrangements and health technology assessment. (Since the agreement, the U.S. Supreme Court lowered the tariff rate from 100% to 10% for all imports.)
Changes in the way health benefits are measured by the National Institute for Health and Care Excellence’s assessments will give more weight to benefits offered by new medicines. An agreement between the pharmaceutical industry and the UK government designed to limit growth in NHS expenditure on branded medicines through industry rebate payments has also been watered down. In 2025, the rebate rate was 23% but under the new agreement this has been cut to 14.5%.
Overall, under the deal, the government has committed to more than double spending on new medicines from 0.3% of gross domestic profit (GDP) to at least 0.6% by 2036, with interim targets of 0.35% of GDP in 2028 and 0.4% of GDP in 2030.
Assuming these GDP targets are met and GDP rises by 1.5% annually, as predicted by the Office for Budgetary Responsibility, the additional annual costs to the English NHS will be at least £1.3 billion in 2028, and £8.8 billion in 2036. The cumulative additional cost will be £2.6 billion by the end of 2028 and £44.7 billion by the end of 2036. Additionally, the projected costs of the agreement are expected to exceed the total annual value of UK medical exports to the United States (£5 billion) before 2031.
The study authors are calling for the full details of the deal and its impact assessment to be made public so the deal can receive parliamentary scrutiny. They emphasize that many of the suggested benefits of the deal, such as claims that higher UK medicine prices will stimulate pharmaceutical innovation and investment in the UK, are uncertain.
Data from BMJ