In December 2025, the UK government agreed to a trade deal with the United States involving pharmaceutical pricing and tariffs, a move that independent experts say could have serious implications for the National Health Service (NHS). The agreement, reportedly brokered between Prime Minister Keir Starmer and former US President Donald Trump, commits the UK to increasing expenditure on branded drugs in exchange for the US refraining from imposing higher tariffs on British pharmaceutical exports.

Since the deal’s announcement, concerns have mounted over its potential financial and health impacts. The Department of Health and Social Care, led by Health Secretary Wes Streeting, has been criticised for providing limited information on the costs and consequences of the agreement. Independent analysis published this week in the British Medical Journal (BMJ) by a team of senior health researchers—including a former adviser to the National Institute for Health and Care Excellence (NICE)—suggests the public has been significantly misled about the deal’s effects.

During negotiations, Streeting had made assurances that the NHS would not be compromised, promising that the health service would not be used as leverage, that services would not be cut to fund the pharmaceutical agreement, and that costs would remain around £1 billion per year in the near term. The new analysis challenges all three claims. It forecasts that drug spending will approximately double as a share of national income over the next decade, rising from 0.3% to 0.6%, with much of the additional funding expected to come from within the existing NHS budget rather than external financing.

Financially, the BMJ report estimates the deal will cost the NHS nearly £3 billion annually over the next few years, and projects cumulative expenses of £44.7 billion by 2036. For context, recent government announcements have cited a £15 billion increase in defence spending, which is less than the projected extra NHS drug costs stemming from this agreement.

The researchers warn this funding shift could result in significant reductions in other NHS services, including cancer screenings, doctor and nurse availability, and funding for treatments such as statins and diabetes medication. Their modelling predicts this could lead to an additional 229,000 avoidable deaths by 2036, a figure described as conservative but sizeable—almost double the number of excess deaths recorded in the UK during the Covid-19 pandemic.

Critics argue the deal appears to prioritise the interests of multinational pharmaceutical companies at the expense of public healthcare needs. The government has faced accusations of a lack of transparency and minimal parliamentary scrutiny, with the deal incorporated into law using a statutory instrument rather than through a full debate. Parliamentary committees with oversight of health, trade, and science have reportedly not held inquiries into the agreement, and a Commons debate was delayed until months after the deal’s implementation.

Calls for greater transparency have intensified following the publication of the BMJ analysis. The Department of Health and Social Care has disputed the report’s findings but has yet to release a detailed impact assessment despite requests from MPs and other stakeholders. Media coverage of the trade agreement has been limited, with some commentators noting a focus on internal political developments overshadowing coverage of a deal that may profoundly affect the future of the NHS.

As the UK prepares for a change in leadership, questions remain about whether the incoming government will revisit the agreement or address concerns regarding its long-term implications for public health services and the sustainability of the NHS budget.