The Prescription
for clarity in complexity

Approval to Access: The 90 Day Myth

A medicine being approved by a NICE Technology Appraisal doesn't mean that it automatically becomes available to or used by every eligible patient. This tool intends to show the system as it really is, not how it is intended to be.

Scope. The Lite version covers medicines commissioned by ICBs following routine NICE technology appraisal. The Full version adds three further routes a medicine can take: high cost medicines, biosimilars and generics, and NHS England commissioned. Each has its own barriers and its own scope, shown at the top of that section.
About this tool

Independent and personal. This tool is produced independently through The Prescription. It reflects general patterns in the medicines access system in England and represents the personal views of the author. It does not represent the views, policies, or position of any NHS organisation, employer, or other body, and does not refer to any specific ICB, provider, or organisation. It is for education and discussion. It is not guidance, and should not be relied upon for clinical, commercial, or commissioning decisions.

A snapshot in time. This reflects the expected process based on national guidance and typical practice. Local variation exists, and NHS structures, policy, and priorities may change the detail or timelines shown here. Last reviewed November 2026.

Concurrent steps. Many of these steps run concurrently rather than sequentially. Durations reflect typical elapsed time for each step in isolation.

Step by step walks through the stages one at a time. Full detail shows every stage and barrier together.
Start here. This is the path a medicine takes after a positive NICE appraisal, and the seven places it can stall. Read it top to bottom, and click any stage to open it.
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