The UK-US pharmaceuticals trade deal could divert up to £45bn from other NHS care to fund higher spending on new medicines, according to a new analysis published in The BMJ.
The paper, by researchers from the University of York, the University of Liverpool and New Zealand’s Christchurch Hospital, estimates preventable deaths in England could reach 229,000 by 2036 without additional NHS funding.
Including the indirect effect on adult social care, that figure rises to 291,000, a toll the authors say would exceed the 137,000 excess deaths recorded in England during the peak of the COVID-19 pandemic.
The deal
Announced on 1 December 2025, the deal, now under scrutiny, gives the UK three years of 0% tariffs on pharma and medical device exports to the US, in exchange for higher NHS spending on innovative branded medicines.
At the time, ministers hailed it as a “landmark” agreement that would safeguard access to medicines and encourage investment in the UK’s life sciences sector. It is only now that the potential cost of delivering the deal has come under fire.
The report estimates that NHS spending on new medicines will more than double from 0.3% to at least 0.6% of GDP by 2036. This would add an estimated £1.3bn a year by 2028 and £8.8bn a year by 2036, resulting in a cumulative cost of £44.7bn.
The authors argue the pressure on NHS budgets could be greater still, as the rebate rate pharma companies pay back to offset spending growth was cut from 23% to 14.5% last year.
Government response
A Department of Health and Social Care (DHSC) spokesperson has disputed the £45bn figure as “not recognised by the department”, saying the deal would be funded from allocations already agreed at the spending review, with future funding settled at the next review.
The spokesperson also said the partnership had given NHS patients access to medicines “they previously would have been denied” and was positioning the UK as a leading location for developing and manufacturing new medicines.
Calls for transparency
The DHSC has completed an internal impact assessment of the deal’s wider costs but has not published it. The paper’s authors, along with MPs across parties, are calling for its release to allow full parliamentary scrutiny.
For its part, the government maintains the agreement will strengthen the UK’s position in life sciences and secure long-term investment in the sector, an ambition both sides broadly agree is worth pursuing, even as they clash over its price tag.
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