A new analysis published in The BMJ has raised serious questions over the long-term public health impact of the UK-US pharmaceutical trade agreement, warning that the deal could divert nearly £45 billion from frontline NHS services by 2036 and contribute to hundreds of thousands of preventable deaths unless additional government funding is provided.

The agreement, announced by the UK government in December 2025, was described as a "landmark" partnership that would improve patients' access to medicines, encourage innovation, and strengthen cooperation with the United States. It secured zero tariffs on UK pharmaceutical and medical device exports to the US for three years. However, researchers argue that the financial commitments attached to the deal could place unprecedented pressure on the National Health Service.

According to the BMJ analysis, the NHS will be required to more than double spending on new branded medicines from 0.3% of GDP to at least 0.6% by 2036. Assuming economic growth forecasts by the Office for Budgetary Responsibility are met, the additional annual cost could reach £8.8 billion by 2036, with cumulative extra spending approaching £44.7 billion.

The study estimates that diverting NHS resources away from existing services could result in around 229,000 excess preventable deaths by 2036. Including the wider impact on publicly funded adult social care raises the figure to 291,000. Researchers suggest patients with cardiovascular diseases, cancer, respiratory illnesses, and gastrointestinal disorders would face the greatest risks because fewer resources may remain for routine diagnosis and treatment.

A key concern focuses on changes introduced in April 2026 to the National Institute for Health and Care Excellence (NICE), the body that decides whether new medicines provide sufficient value for NHS funding. NICE measures value using Quality Adjusted Life Years (QALYs), a tool that combines how much longer people may live with improvements in their quality of life. The government has raised the cost-effectiveness threshold, allowing the NHS to pay more for treatments offering similar health benefits.

Yet NICE's own estimates suggest the higher threshold would lead to approval of only two to five additional medicines each year, while it already approves more than 90% of medicines it assesses. The researchers therefore argue that the policy is more likely to increase prices for medicines already entering the NHS than substantially expand patient access.

The analysis also notes that the UK remains a net importer of medicines, meaning the economic gains from zero US tariffs may be smaller than suggested. It further points to a recent US court ruling that reduced proposed pharmaceutical tariffs, potentially limiting the trade benefit.

The authors have urged the Department of Health and Social Care to publish its unpublished impact assessment and called for full parliamentary scrutiny before further policy changes proceed.

"The government's willingness to accommodate industry pressure while the NHS absorbs the resulting costs raises important questions about transparency and accountability," the authors write.

They add, "More importantly, it emphasises a broader structural problem at the heart of a health system conceived with the intention of delivering equitable, patient-centred care that is now reduced to underwriting risk in global pharmaceutical markets."