The government says, “The NHS is not for sale to the private sector and never will be,” but that is clearly not true because private companies, including U.S. health care companies, are already active in the NHS. Under the Health and Social Care Act 2012, market-based approaches have been significantly expanded and a large number of contracts have been awarded to private providers. In 2018/19, the NHS used $9.2 billion for private-sector health services. This level of privatization within the NHS and any extension of those funds could all be blocked by a trade deal with Trump. As far as drug pricing is concerned, the result of Tuesday night`s election is almost negligible. The Trump administration has repeatedly stated that rising drug prices abroad is a priority, potus itself holding foreign countries responsible for the high price of domestic drugs (and no, I don`t know, for for-profit health care and the world`s largest pharmaceutical lobby!) Meanwhile, Biden has recently experienced fighting for the U.S. pharmaceutical industry – under the Biden-Obama administration, the U.S. tried to join the Trans-Pacific Partnership (the TPP, called cpTPP after a few changes) that offers similar legs and, in some cases, even worse for pharmaceutical companies. The Trump administration has left the TPP, but Biden could try to get back into his new iteration to what would force Britain to negotiate its trade terms.

U.S. drug groups aspire to “full market access” in the UK and have “competitive prices.” In reality, this means that U.S. companies expect the NHS to treat all eligible patients with their new drugs at prices set under open market conditions. Currently, NHS drug prices are controlled by the National Institute for Health and Care Excellence (Nice), which evaluates their value for money. Under new trading conditions for “competitive prices,” a trade agreement between the United States and Britain could deter Nice from setting prices based on value. The government this week released its much-anticipated negotiating targets for a U.S.-U.K. trade deal, which contained categorical assertions that NHS and drug prices are not on the table. But this is not a victory for all those who want to protect our NHS. These are just words in the air, because the documents leaked from the trade discussions that have taken place so far show that the rules affecting NHS and drug prices have already been discussed. And the British negotiating objectives show that there is still a lot on the table, which poses serious risks for our NHS. If (and if) negotiations on a trade agreement begin, the real test will come if the political profile and temperature on both sides of the Atlantic are increased.

The US pharmaceutical lobby has long complained that it is not getting enough prices for its drugs in the UK, while the UK`s pharmaceutical bill has risen by 22% over the past five years and the NHS is increasingly forced to refuse or ration drugs due to high prices. The industry wants more and has pushed the U.S. government to use trade negotiations between the U.S. and Britain as a way to drive up drug prices. Nevertheless, we draw attention to key areas that could affect the cost of NHS drugs, based on existing U.S. trade agreements with other countries and priorities that the U.S. pharmaceutical lobby has outlined to the U.S. Trade Representative12.