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Analysis by Huseyin Naci and colleagues1 overlooks the broader policy context influencing the National Health Service expenditure on branded medicines. The Department of Health, through the Voluntary Scheme for Branded Medicines Pricing and Access scheme and the commercially equivalent statutory scheme,2 ensures the branded medicines budget growth rate (2%)2 remains below the overall health-care budget growth rate (5·9%).3 If the National Institute for Health and Care Excellence (NICE)’s decisions lead to expenditure surpassing the agreed amount, the pharmaceutical industry covers the excess via rebates—estimated to be 22·9% of branded medicine sales revenue in 2025.
