The Single National Formulary – friend or foe to pharma?

Of all the healthcare policies the government blasted out over the summer, one should have stood out for pharma.

The NHS is edging towards one of the most radical reforms in its history: the creation of a single national formulary (SNF).

Ministers pitch it as the end of the ‘postcode lottery’ and a bold leap towards equity, efficiency and speed of access. For pharma, however, the SNF is shaping up as both an existential challenge and a potential opportunity. The industry’s response will be critical: lean in; shape the rules and gain from standardisation – or resist and risk being shut out of the room.

The 10-Year Health Plan and the Life Sciences Sector Plan cast the SNF as a neat solution to two problems that have long dogged the NHS.

One is variation: patients in different regions facing very different prescribing choices. The other is delay: slow, duplicative processes for getting new medicines into formularies.

They’re not wrong about the problems, and a single formulary could, in theory, deliver what pharma has been asking for: one clear route to market; a streamlined national decision instead of multiple ICBs with multiple different timelines. For market access teams, this is attractive.

The UK could finally look more like Australia or New Zealand, with national consistency and stronger purchasing leverage.

At HSJ Information, we wanted to find out what pharma really thought about this. So my colleague and principal consultant Jyotika Singh surveyed a wide range of industry voices – and generally, it must be said, most were sceptical.

The majority of pharma interviewees see more challenges than benefits. Roles shaped views though: market access specialists tend to view the SNF as a simplifier; sales teams and senior leadership see it as a barrier, making the UK market less attractive for launches.

Overall, most respondents leant negative, warning that bureaucracy, supply risks and loss of local engagement will outweigh efficiency gains.

Put simply: while there are glimmers of upside, the sentiment across pharma is that the SNF is more threat than opportunity – at least in its current conceptual form.

The central paradox is that an SNF designed to cut red tape may actually multiply it. Stakeholders predict a huge new governance structure – a national formulary board with subcommittees for each specialty; endless consultations across Trusts, even for single-drug decisions; and legal wrangling with the ABPI, BGMA and manufacturers over monopolistic formulary listings.

Instead of ‘do once and done,’ the SNF risks becoming ‘NHS England 2.0’ – just as the government dismantles NHS England as a ‘bureaucratic quango,’ it may create a new one.

Comparisons with other systems provide both inspiration and warning. Wales and Scotland save resources by lifting NICE appraisals and making selective HTA decisions centrally. Australia and New Zealand show how centralisation can streamline – but also delay. Rosuvastatin took 19 years to enter the New Zealand formulary.

The lesson for pharma is stark: if the SNF is under-resourced or overly rigid, launch delays could stretch from months to years.

From the industry’s perspective, the risks are acute, and some of our interviewees noted the following issues.

Market access barriers are certainly a possibility. A ‘winner takes all’ formulary could lock out entire product classes if only one drug is selected first-line.

Commercial incentives will also take a hit. Fewer viable launches may reduce competition, discourage investment and shrink the UK’s status as a launch market.

National reliance on single products could mess with supply chain, amplify shortages, with knock-on price and availability risks.

And there could be a negative knock-on to encouraging local pilots: pharma often funds local project work – nurse-led reviews, shared-care pilots and adherence programmes. If local formularies vanish, so too may these partnership opportunities.

This is against the background of a potential innovation squeeze too: with rebates, budget caps and fewer entry routes, innovators may think twice before prioritising the UK.

The Life Sciences Vision promised that Britain would be the best place to launch and scale new therapies. An SNF, unless carefully designed, could deliver the opposite.

Pharma must also reckon with how clinicians respond. The SNF may guarantee equal access, but it will almost certainly erode local clinical autonomy.

Shared-care protocols, off-label use and paediatric prescribing – all areas where local flexibility is critical – could be shut down. Antimicrobial formularies tailored to local resistance patterns may not fit a one-size-fits-all SNF.

All this assumes prescribers will prescribe as predicted. Without their buy-in, prescribers may disengage altogether, leading paradoxically to less adherence and more off-formulary drift.

For industry, this means that a national ‘yes’ may not translate into a local reality of prescribing behaviour.

The interviews behind this report show a nuanced but clear trend:

• Pro-SNF (minority, mostly market access roles): they see simplification, faster routes, procurement efficiencies and the ability to plan nationally,
• Anti-SNF (majority, sales/senior roles): they foresee reduced UK attractiveness, slower launches, supply bottlenecks and diminished innovation.

If the SNF is inevitable – and politically, it looks likely – the question becomes how to make it work for pharma’s best interests. Three red lines stand out:
The first is a culture of transparency and appeal rights. Decisions must be evidence-based, open to challenge and aligned with NICE. A formulary that simply lists ‘winner drugs’ without rationale will invite litigation and mistrust. without rationale will invite litigation and mistrust.

Secondly, value beyond price must become more than a nice to have. The framework must assess long-term outcomes, adherence and system costs – not just unit price. Otherwise, cheaper short-term drugs will crowd out innovations that actually save money downstream.

Lastly, safeguards for innovation must be built in. A phased approach – starting with new, innovative drugs – could help. Local variation must remain possible for rare diseases, paediatrics and antimicrobial stewardship. Above all, pharma must retain a commercial incentive to launch in the UK.

The draft plan is thin on practical detail. But the critical next steps are clear:
Establish governance and scope early, with pharma at the table. Resource the SNF adequately – otherwise delays are inevitable. Phase implementation to avoid ‘big bang’ disruption. And build digital systems that make prescribing transparent and consistent.

For pharma, the imperative is to shape the debate now. The SNF could close doors or open them, depending on how much industry pushes for workable safeguards.

On paper, the SNF is about fairness. In practice, it could prove a hollow victory – levelling down rather than levelling up. Patients may wait longer, clinicians may disengage and innovators may look elsewhere.

For pharma, the best interests are clear: don’t just oppose, but demand a formulary that is transparent, resourced and genuinely innovation-friendly. If industry fails to act, the UK risks becoming a second-tier market – consistent, yes, but consistently unattractive.

The SNF debate is not just about bureaucracy, it’s about the UK’s future as a life sciences powerhouse. And on that, pharma cannot afford to sit back.

Oli Hudson is Content Director at HSJ Information. Go to hsjinformation.co.uk