Global drugmakers including Merck & Co., Eli Lilly & Co. and AstraZeneca Plc are pausing or canceling investments in the UK while throwing barbs at the lack of competitiveness of its business environment. They have a point. Britain directs less of its health spending to medicines and claws back far more in sales rebates than peer nations. Call it the curse of a big fish in a small pond: a single-payer health system that gives the government great leverage over drug pricing and expenditure — though at increasing cost, it appears, to the wider economy.
Like other state-funded systems, Britain’s National Health Service caps the growth in spending on branded medicines via complex formulas negotiated with the pharma industry to control the cost to taxpayers. If sales exceed the allowed path, drugmakers are liable to pay rebates. For 2025, the UK rate for newer branded medicines was set at 22.9%, far higher than expected. Across Europe, average clawback rates are below 10%, according to the Association of the British Pharmaceutical Industry, whose members include Merck, Lilly, Astra and Sanofi SA.