Figures from July 2026 reveal a sharp increase in terminations, cases where firms withdraw entirely from the appraisal process, sparking debate over whether this reflects industry-wide changes or systemic issues within NICE’s operations. The most recent metrics, released in August 2026 and dated July 2026, include a detailed breakdown of NICE recommendations, including terminations, as shown in Figure 1.
Under the Voluntary Scheme for Branded Medicines Pricing and Access (VPAG), pharmaceutical companies are required to present proposals for NICE’s review. When they fail to do so, the process is classified as a termination, though this also applies when evaluations stall due to incomplete submissions. Terminations are defined as appraisals that could not be completed because companies chose not to submit to NICE, and they are referred to interchangeably as non-submissions and terminations.
Historically, termination rates peak in May and June, though no official reason has been given for this seasonal trend. The Department of Health and Social Care (DHSC) states that the current termination rate, 20% of all appraisals in 2026/27, falls within past averages, indicating no urgent concerns at present.
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However, recent trends suggest a more serious issue. Since the data available in the metrics dated July 2026, two additional terminations have occurred by 1st July 2026, according to TACRAWLR data from Tom Snell. While the financial year is not yet complete, the figures may exceed the previous peak of 25 terminations (26% of appraisals) recorded in 2025/26. The DHSC’s metrics acknowledge that terminations are permissible, though no specific limit has been defined. NICE’s financial reports, however, warn of a potential shortfall in operating income from appraisal fees, with a £500,000 deficit already noted in September 2026 for Technology Appraisals and Highly Specialised Technologies.
Patient advocacy groups, including the Blood Cancer Alliance, have long argued that non-submissions restrict access to innovative treatments. The issue resurfaced during a pre-meeting ahead of NICE’s July 2026 operational review, where stakeholders urged a deeper examination of terminations. Their request included analyzing deferrals, delays, and pauses in appraisals, as well as the influence of Most-Favoured Nation pricing agreements, particularly those linked to the UK-US trade deal. The metrics tracker notes that the operational review meeting, held on 9th July 2026, included a request for expanded reporting on non-submissions, though public notes from this meeting are not yet available.
