New National Formulary signals long overdue shift in NHS medicines policy – how pharma can navigate the change

The announcement that NICE is planning to remove automatic approval for hundreds of medicines and instead consolidate national prescribing into a single National Medicines Formulary marks a major, and welcome, inflection point for the NHS.

At Scott McKenzie Consultancy, we’ve long argued that prescribing decisions must stop being viewed through the narrow lens of short term cost containment and instead be treated as a strategic lever to improve patient outcomes, reduce system demand and drive long term value. The National Formulary is an important step in that direction.

It’s time to stop the postcode lottery for patients

For too long, siloed thinking has dominated NHS medicines policy. Prescribing costs were managed locally, often in direct contradiction to national guidance, with ICBs and Health Boards engaging in medicine switches and restrictions based not on patient outcomes but on item cost savings.

The result? A postcode lottery for patients, missed opportunities to prevent deterioration, and millions of pounds wasted on avoidable GP appointments, outpatient referrals and non-elective admissions to hospital.

As I’ve written in my recent blog, Medicines Optimisation: More Than Just Cost Savings, the real cost of medicines is not the price per pack. It’s the cost of not using the right medicine, at the right time, for the right patient.

When we fail to optimise therapy, support adherence or review outdated treatments, we’re not saving, we’re simply deferring a larger, more expensive problem.

That’s why the National Formulary is so important.

Golden opportunity for pharma – as long as you’re ready to take advantage

It creates a new framework, one that, if implemented correctly, will standardise access to clinically effective medicines, reduce variation and focus attention on medicines as enablers of prevention, control and reduced escalation.

Let’s be clear, this isn’t about removing local flexibility. It’s about removing unwarranted variation. It’s about ensuring patients can access treatment without navigating needless layers of prior approval. It’s about finally aligning NICE guidance, system funding flows, and real-world prescribing practice.

The message is simple – national consistency, locally delivered.

As this new formulary takes shape, pharmaceutical companies will be navigating a new operating environment. There will be winners and losers. Some products will lose historic local approval. Others will face increased scrutiny around real world impact. But for those who are ready, this is a golden opportunity.

How you can protect access and proactively position medicines within the new formulary structure

Over the coming months, I’ll be working closely with the pharmaceutical companies who retain my time to manage the transition, protect access and proactively position medicines within the new formulary structure. This means:

• Mapping which products are likely to remain on formulary, and which are at risk.
• Developing value propositions that link medicines to broader system goals, e.g. reduced non-elective admissions, improved outcomes, better patient experience.
• Supporting teams to engage ICBs, Medicines Optimisation Leads, and clinical stakeholders with evidence based narratives that align with NHS priorities.
• Preparing Market Access and Key Account teams to operate in a world where outcomes, not acquisition cost, dictate adoption.

This isn’t just about compliance. It’s about leadership. The companies that thrive under the National Formulary will be those who embed medicines within care pathways, support system pressures, and invest in outcome led partnership models.

This is the agenda I’ve been pushing for more than 20 years, inside the NHS, in collaboration with industry. The National Formulary isn’t a threat. It’s the enabler we’ve been waiting for. So, let’s make it work.

If you’re a pharmaceutical company looking to get ahead of the change, manage formulary risk, or reposition your medicine in light of the upcoming reforms, please drop me a message.

Scott McKenzie helps pharmaceutical, medical technology and device firms get their products and services in front of the right NHS decision-makers. In 2023 alone, he helped land 53 new NHS projects and he added a further 28 in 2024. His 12-month coaching and mentorship programme – revamped and expanded for 2025 – offers tools, extensive NHS customer insights and direct decision-maker introductions to get your projects over the line. Scott’s support is grounded in real world experience of what gets approved, funded and sustained across systems, places and provider collaboratives, turning strategy into impact and frustration into progress. Find out more here.