A prominent pharmacist has criticised the ongoing row over medicine prices as a distraction from the UK’s persistent problem of patients not taking their prescribed drugs, which costs the health service hundreds of millions each year.

Norman Niven, chief executive of The Medication Support Company, argues that addressing medication non-adherence directly would reduce the overall demand for medicines and ease the burden on the National Health Service (NHS).

The dispute centres on the Voluntary Scheme for Branded Medicines Pricing, Access and Growth (VPAG), a five-year agreement introduced in January 2024 to manage NHS spending on branded drugs. Pharmaceutical firms agree to a cap on spending growth and return any overspend to the NHS.

Tensions rose in 2025 when the government raised the growth cap to 22.9 per cent, prompting criticism from industry leaders. Some companies halted investment in the UK, citing uncertainty. A review of the scheme concluded without agreement in August 2025, leaving the future of pharmaceutical commitments unclear.

Science Minister Lord Patrick Vallance told the BBC: “The price the NHS pays for medicines will need to rise to stop a wave of pharmaceutical investment leaving the UK.”

Mr Niven, a pharmacist with more than 30 years’ experience, has focused on combating non-adherence, often described as a “silent epidemic” in healthcare. Estimates suggest up to 50 per cent of patients do not take medicines as prescribed, contributing to poorer health outcomes and wasted resources. He told the BBC: “Medication non-adherence leads to poorer population health, which creates a raft of downstream problems from hospital re-admissions to an increased burden on the social care sector. Ultimately, the cost to the NHS is enormous. Instead of quibbling over the price the NHS pays for drugs, we should be tackling the problem at source, reducing the need for so many drugs to be dispensed in the first place.”

Medicines are the NHS’s second-largest expense after staff salaries. In 2023–24, spending reached £19.9 billion, with pharmacies dispensing 1.26 billion items in 2024–25, according to NHS England and the NHS Business Services Authority.

Mr Niven explained that both unintentional and intentional non-adherence add to the burden. He said: “It is easy to understand unintentional non-adherence; sometimes people, especially older people, simply forget to take their meds. But intentional non-adherence represents a different class of problem; it is much more significant in terms of numbers, and it is a silent killer. Some people don’t finish the course they’ve been prescribed, whilst others will tell their doctor their meds aren’t working when in fact they haven’t been taking them. The associated costs, from unnecessary hospital admissions and re-admissions, and social care visits, mount up very quickly.”

A 2013 study estimated the annual cost of non-adherence to NHS England at nearly £1 billion for just five conditions:

• Asthma (£130 million)
• Type 2 diabetes (£100 million)
• High cholesterol and coronary heart disease (£120 million)
• Hypertension (£390 million)
• Schizophrenia (£190 million)

Mr Niven’s firm uses a remote audio-visual system, known as PAMAN (Pharmacy Assisted Medication Adherence Network), installed in patients’ homes. Pharmacy technicians conduct video calls to observe and guide medication intake, offering advice on dosage, timing and side effects. The system includes secure prompts, wellness checks and integration with tamper-proof cabinets (Remlok) for precise dispensing.

He explained: “Witnessing patients at home taking their medication is the only way ensure the right drug is taken at the right time, in the right dosage. Our system makes that possible, and our pharmacy technicians become a trusted source of advice and support.”

The service supports patients with complex needs, including dementia, Parkinson’s and diabetes management, and generates reports for carers. It aligns with NHS goals for independent living.

Mr Niven pointed to Knowsley Council in Merseyside, which has used PAMAN for four years, saving more than £1.6 million for 100 patients, or about £692 per patient monthly. Hospital admissions and re-admissions have dropped, discharges have been quicker, and an average of 10 bed-days per patient have been saved.

He urged: “It’s far beyond time that the government and NHS stopped trying to deal with the effects of this problem and started tackling the root causes.”

As the VPAG impasse persists into late 2025, with firms given until October to decide on participation, Mr Niven warns that without broader adherence strategies, rising drug costs will only compound the NHS’s challenges. Enhanced remote monitoring could bridge NHS and social care, potentially saving billions while improving outcomes in medication adherence and chronic disease management.