The Top 10 Most Expensive Drugs Prescribed in the NHS in 2025

In 2025, the NHS continues to fund the purchase of groundbreaking medical therapies that offer transformative, sometimes curative, benefits for patients suffering from rare, chronic, or previously untreatable conditions. However, it comes at a price. While these drugs potentially offer significant medical advancement, their costs can be staggering-often exceeding the price of an entire year of inpatient hospital care. The top 10 most expensive drugs currently prescribed or considered by the NHS reflect a shift toward highly targeted treatments, especially in the fields of gene therapy, oncology, and neurology.

1. Hemgenix – £2.6 Million

At the top of the list is Hemgenix, a one-time gene therapy for haemophilia B. It made headlines in June 2025 when the NHS administered it to a patient at a record cost of £2.6 million, making it the most expensive drug ever prescribed in the UK¹. Delivered via a single intravenous infusion, Hemgenix introduces a functional copy of the Factor IX gene into liver cells, enabling the production of the clotting protein absent in haemophilia B patients. It has the potential to drastically reduce, or even eliminate, the need for ongoing infusions of clotting factor concentrate-marking a significant shift in the standard of care for this condition.

2. Casgevy – £1.7 Million

Second on the list is Casgevy, a CRISPR-Cas9 gene-editing therapy approved for beta-thalassaemia, an inherited blood disorder characterised by defective haemoglobin production. Casgevy corrects the underlying genetic defect in the patient’s own stem cells, potentially curing the condition and freeing patients from lifelong blood transfusions. At £1.7 million per treatment, it has begun to roll out via the Innovative Medicines Fund, enabling limited NHS access for eligible patients².

3. Zolgensma – £1.7 Million

Another gene therapy, Zolgensma, is prescribed for spinal muscular atrophy (SMA), a severe neurodegenerative condition affecting motor neurons in infants and young children. With a global list price of £1.7 million, Zolgensma replaces the defective SMN1 gene with a functioning copy via a one-time infusion. While not routinely available across the NHS, select patients have received the drug through individual funding requests or special programs, offering families a new sense of hope in the face of what was once a fatal diagnosis³.

4. Spinraza – £500,000 to £700,000 (First-Year Cost)

Also used to treat Spinal Muscular Atrophy (SMA), Spinraza is a spinal injection therapy that modifies gene expression to increase levels of the survival motor neuron protein. Although not curative, it can significantly improve motor function and survival. The treatment involves multiple doses in the first year, costing up to £700,000, with ongoing maintenance doses required every four months, adding to the long-term cost burden⁹.

5. Hemlibra – Up to £500,000 Annually

Used for haemophilia A, Hemlibra is a bispecific monoclonal antibody that mimics the function of Factor VIII, allowing for subcutaneous administration instead of intravenous factor replacement. Depending on the patient's weight and dosing schedule, costs may exceed £500,000 per year. It has significantly improved bleeding control and quality of life for many patients⁷.

6. Blincyto – £90,000 per Course

Blincyto is a bispecific T-cell engager (BiTE) antibody used in the treatment of acute lymphoblastic leukaemia (ALL). It helps the body’s immune system identify and destroy cancer cells by bringing T-cells into proximity with malignant B-cells. A full treatment course costs approximately £90,000, and it is reserved for aggressive or relapsed forms of the disease⁸.

7. Mounjaro – £2,000+ Annually

In the realm of metabolic health, Mounjaro (tirzepatide) has emerged as a high-cost but promising treatment for severe obesity and type 2 diabetes. Approved for NHS use in patients with a BMI over 35 and at least one obesity-related comorbidity, it mimics the actions of two gut hormones to regulate appetite and blood sugar. Priced between £122 and £200 per month, annual costs exceed £2,000, but the long-term benefits-reduction in cardiovascular risk, joint strain, and diabetes-related complications-are considerable⁴. Mounjaro has received a significant amount of PR and publicity although many remain critical of its use for weight loss, when potentially health coaching and nutritional support could provide similar benefits.

8. Kisunla – £40,000 to £80,000 Annually (Rejected by NICE)

Kisunla (donanemab), a monoclonal antibody targeting beta-amyloid plaques in Alzheimer’s disease, has demonstrated the ability to modestly slow cognitive decline in early-stage patients. However, despite clinical promise, NICE rejected it for NHS funding in 2025 due to high cost and uncertainties around long-term cost-effectiveness⁵. The estimated annual treatment cost of up to £80,000 placed it out of reach for routine use.

9. Leqembi – £40,000 to £80,000 Annually (Rejected by NICE)

Similarly, Leqembi (lecanemab) has shown efficacy in slowing Alzheimer’s progression by targeting amyloid plaques. Like Kisunla, it was not recommended by NICE for NHS use in 2025, as the cost of up to £80,000 annually could not be justified based on available health economics data⁶.

10. CAR-T Therapies – £250,000 to £300,000

Various CAR-T cell therapies, such as Kymriah and Yescarta, used in blood cancers like lymphoma and leukaemia, continue to represent one of the NHS’s most expensive therapeutic categories. These personalised treatments involve extracting a patient’s immune cells, modifying them to attack cancer, and reinfusing them. Though not new in 2025, they remain high on the list of expensive interventions, costing £250,000 to £300,000 per patient, often funded via the Cancer Drugs Fund.

Implications for Healthcare and Physiotherapy

These advanced therapies not only extend lifespan but often result in significant functional improvements, which has important implications for allied health professionals, particularly physiotherapists.

• Haemophilia patients treated with Hemgenix or Hemlibra may experience a dramatic reduction in joint bleeds and synovitis, improving mobility and long-term joint preservation. Physiotherapists can play a vital role in maintaining strength and encouraging activity post-treatment.
• Children with SMA treated with Zolgensma or Spinraza may develop previously unattainable motor skills. Early and ongoing physiotherapy is essential to maximise these gains, address muscle imbalances, and support developmental milestones.
• Patients using Mounjaro may experience rapid weight loss. Physiotherapy is essential in supporting healthy biomechanics, managing joint pain, and sustaining physical activity as part of a multidisciplinary obesity intervention.
• As Alzheimer’s disease therapies evolve, physiotherapists may be increasingly involved in long-term motor function maintenance and fall prevention, especially as cognitive therapies begin to slow progression.

The high cost of these medications raises complex questions about value, access, and equity in public healthcare. While their clinical benefits can be profound, affordability and sustainability within the NHS remain contentious. Balancing innovation with cost-effectiveness will be crucial as more high-cost therapies reach the market.

As the NHS adapts to these new realities, the role of physiotherapy and other rehabilitation services will grow ever more important-not just to enhance the benefits of these life-altering drugs, but also to ensure patients regain independence, function, and quality of life.

References

1. NHS England. First NHS patient receives world’s most expensive drug, Hemgenix, at £2.6m. NHS News, 11 June 2025. https://www.england.nhs.uk/
2. Financial Times. NHS in England to roll out £1.7mn Crispr gene editing drug. 10 June 2025.
3. BBC News. NHS patient receives £1.79m Zolgensma drug for spinal muscular atrophy. 3 January 2025.
4. The Sun. Exact weight you need to be to get free Mounjaro from your GP. 15 June 2025.
5. Reuters. Lilly to appeal after UK agency opposes reimbursement for Alzheimer’s drug Kisunla. 18 June 2025.
6. NICE. Lecanemab not recommended for routine NHS use due to cost concerns. NICE News, 6 June 2025.
7. Roche. Hemlibra® dosing and cost information. Roche Product Monograph, 2025.
8. NHS England. Cancer Drugs Fund list – Updated pricing guidance, May 2025.
9. Biogen. Spinraza (nusinersen) UK pricing and reimbursement status. Biogen UK Ltd, 2025.