Improving access to medicines in Scotland

In this blog, we break down the drugs that were rejected, the underlying issues, and what we’re doing to campaign for better medicines access in Scotland moving forwards. 

In 2025, the SMC decided not to recommend two targeted treatments for ER-positive, HER2-negative metastatic breast cancer, capivasertib with fulvestrant and elacestrant, for use on the NHS in Scotland.

This came after another SMC decision not to recommend alpelisib in combination with fulvestrant for a similar group of patients in 2022. All three treatments are available on the NHS in England, Wales and Northern Ireland, meaning patients in Scotland are the only patients in the UK that can’t access them.

Both capivasertib (for patients with PIK3C3A3/AKT1/PTEN-alteration) and elacestrant (for patients with an ESR1 mutation) would have been the first targeted treatments available for people with those mutations. They could have offered patients the hope of extra time before their condition progressed, but sadly their rejections have left them with fewer treatment options and having to rely on chemotherapy earlier compared to patients elsewhere in the UK.

One of the driving factors behind these decisions is the way the SMC assesses new cancer drugs. When a new drug is being reviewed, the SMC requires proof of how it performs against the standard line of treatment, which for these patients in Scotland is chemotherapy.

In contrast, NICE in England assessed these drugs against newer treatments which are approved for use in England. In Scotland, these treatments were not approved by the SMC, so can’t be used as a comparison.

We’re concerned that the way the SMC assesses drugs is negatively impacting treatments for breast cancer. If new, targeted treatments are rejected, the gap in access between Scotland and the rest of the UK will continue to widen.

Getting cancer drugs approved by the SMC is only part of the picture for people wanting to access them. Many of these treatments need people to get a genomic test to identify whether they have a specific gene alteration that would make them eligible to receive the drug.

But there is no agreed funding for this genomic testing in Scotland. This means that some healthcare teams can’t do the tests and so there is a risk that people can’t get access to potentially life-extending and life-saving treatments. We’ll continue to raise issue with the Scottish Government.

Our first priority has been to ensure that patients in Scotland can access these treatments.

We know that many will urgently need them to stop their cancer progressing, and don’t have time to wait. We’ve therefore been meeting with the pharmaceutical companies to understand if they will resubmit the drugs.

We’re pleased to say that both of these drugs have been resubmitted. As the appraisals are progressing, we’ll work with the SMC to make sure the real-life experiences of patients are considered during the decision-making process.

While the SMC makes its decisions independently of the Scottish Government and Parliament, we can urge politicians to highlight the unequal access in Scotland. That’s why, in the last parliament, we also raised this issue with the then Cabinet Secretary for Health and Social Care when we met with him, and again in writing, and ensured it was raised in a debate on metastatic breast cancer in Holyrood.

We’ll be making sure this is a priority for the new Scottish Government, including the Cabinet Secretary, and incoming parliamentarians. We’re also teaming up with a new network of MSP ambassadors, who will champion the things that matter most to people affected by breast cancer, including access to treatments.

We’ll also be working with other charities and patient groups like METUPUK and Make 2nds Count to make progress on this issue. Together, we wrote a letter to the new chair of the SMC to raise this issue and highlight concerns we have over genomic testing and timescales.