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The cost of medicines and the amount the National Health Service (NHS) spends on supplying them to patients has been closely monitored and managed for over 30 years. In 1994, the Audit Commission noted that £3.6 billion spent on drugs prescribed by general practitioners in England and Wales consumed about 10% of NHS expenditure and was four times higher than hospital drug expenditure.1 Per capita expenditure on medicines was below the Western European average and less than the USA, with ‘no conclusive evidence that the higher drug expenditure in these countries leads to better health’. The report’s authors highlighted that international comparisons ‘are complicated by fluctuations in exchange rates and purchasing power, differences in product availability, strengths, formats and pack sizes’.1