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A report from the Association of the British Pharmaceutical Industry (ABPI) has identified ‘unwarranted variation’ in patient access to new drugs across Scotland.
In a report published on 29 October 2026, the ABPI revealed that glucagon-like peptide-1 (GLP-1) and non-statin, low-density lipoprotein-lowering therapies were prescribed as many as ten times more in some areas than others.
While this may be partially explained by variability in need and specialist centres being located in certain health boards, this did not fully explain the variation in prescribing rates per population, the report noted.
It also highlighted other barriers to access, such as a lack of local remuneration arrangements and health boards not adding drugs to local formularies in a timely way.
Some health boards did not add GLP-1 receptor agonists drugs to formularies until more than one year after they were recommended by the Scottish Medicines Consortium (SMC), particularly with regard to obesity, the report continued.
For this indication, the report said: “Although SMC acceptance was published in June 2024 alongside national consensus guidance, only a small number of NHS boards have implemented formulary approval with defined patient pathways, often for more restricted populations than outlined in the consensus.”
However, where local pathways and formulary arrangements were in place, prescribing of new drugs accelerated, the ABPI found.
The report highlighted that in the Scottish Borders, there was little or no prescribing of migraine prevention (i.e. calcitonin gene-related peptide) therapies during the first 12 months following SMC acceptance, but after local pathways were established, the health board had the highest per-capita prescribing rate of all Scottish health boards at 24 months post SMC acceptance.
It also identified variation in availability of pathology required for various drugs, such as for cardiac myosin inhibitors, which require CYP2C19 genotyping and echocardiography. Capacity in these services may also influence the pace of implementation across health boards, the report suggested.
Victoria Jordan, executive director of patient access at the ABPI, said: “Scotland has a strong and respected system for assessing new medicines. But this report shows that the use of some accepted medicines can vary widely between NHS boards, and that differences in patient need do not fully explain this.
“While the data we have does not tell us everything, it does show we need to look more closely at this issue. When avoidable barriers slow things down, patients can wait longer than they should for medicines already judged effective and good value.
“We need to plan and work together across government, the NHS, clinicians, patients, academia and industry. That way, we can help make sure national SMC decisions have benefit to patients, wherever they live.”
The report made several recommendations to the Scottish government and NHS Scotland, including that they consider protected funding for a small number of high-impact medicines, where local budget pressures could cause delays.
It also suggested that planning for workforce, testing and care pathways could begin before the SMC publishes its advice.
Responding to the report, a spokesperson for the Scottish government said: “We will carefully consider the findings of this report and have been clear our reforms to NHS boards are intended to improve equity of access to services and reduce the unwarranted variation and bureaucratic barriers we currently have in place.”
In its five-year plan, which runs from 2026 to 2031, the Scottish government said that during this parliament it would replace the current 14 territorial health boards with two strategic health boards and build on planned reforms to further reduce the number of special health boards.
