A national tool for monitoring availability of recommended medicines in Wales (poster PP92)

Poster presented at the Health Technology Assessment International (HTAi) 2026 Annual Meeting, June 2026, Istanbul, Turkey.

Introduction: Health boards and NHS trusts in Wales are required to make medicines available for prescribing within 60 days of approval from national health technology assessment bodies in England and Wales. This 60-day deadline or implementation time is routinely monitored by a national Formulary Status Report (FSR). National implementation issues such as awaiting agreement of commercial arrangements can delay the monitoring start date (MSD), potentially impacting patient access. The project evaluated how many medicines are made available within the 60-day deadline and how much of an impact a delayed MSD had on the time to medicines availability. 

Methods:

• Sample: The analysis included 394 medicines that received positive recommendations from the National Institute for Health and Care Excellence or the All Wales Medicines Strategy Group between January 2021 and July 2025, which were monitored on the FSR. 

• Primary outcome: Implementation time was calculated as the number of days between appraisal approval and the date the medicine became available to routinely prescribe. 

• Definitions: A delayed MSD was defined as any national implementation issue that prevented the process from beginning at the time of appraisal approval. 

• Statistical analysis: Mean implementation times were calculated for all medicines, as well as for subgroups with and without a delayed MSD. Differences between groups were analysed using an unpaired t-test. 

Results:

• The overall mean implementation time for all medicines was 38.2 days. 

• Medicines with a delayed MSD had a significantly higher mean implementation time of 63.5 days (n=151; range: 10–366) compared to 22.5 days for those without a delay (n=243; range: 1–65; p <0.001). 

• Overall, 87% (342/394) of medicines were made available within the 60-day requirement. 

• >99% (242/243) of medicines without an MSD delay met the <60-day target for availability, compared to 66% (100/151) of medicines with an MSD delay. 

• MSD was delayed for multiple reasons, most often due to issues in finalising a commercial arrangement (67% of delays (n=129) but also due to awaiting marketing authorisation (8.8%), awaiting stock availability (10.4%), awaiting product launch (5.7%) and other reasons such as lack of biomarker testing (8.3%).  

Conclusions: The FSR national tool monitors timely access to medicines in Wales, with most medicines being available to prescribe within the 60-day deadline. National implementation issues appear to be a significant barrier, more than doubling the average wait time and reducing target compliance. Potential reasons for these national implementation issues may include awaiting agreement for commercial arrangements, stock availability issues, and the availability of required biomarker testing. These contribute to delays in making treatments available to prescribe.  To ensure the 60-day deadline is consistently met, further work is required to investigate the specific causes of service-related delays and identify strategies to mitigate their impact on patient access.