Three strikes and you are out!

Some Clinical Commissioning Groups (CCGs) have been artificially restricting access to advanced therapies 


For some time, NRAS has been concerned that some Clinical Commissioning Groups (CCGs) have been artificially restricting access to advanced therapies (biologics, biosimilars/JAK inhibitors) in England, and we undertook a Freedom of Information request to all CCGs about this in 2019.  

A number of NRAS members also got in touch to tell us that they were told they could only try three or four advanced medicines. As one NRAS member put it–– ‘three strikes and you are out!’.  

If you live in England and have experienced ‘three strikes and you are out!’, or a similar artificial restriction on the number of advanced therapies you could try to find a treatment that works, please get in touch.  

Send your experience to If you are happy to, please also share the first half of your postcode so we can see which CCG you receive care from, and let us know whether you would be willing to share your experience in an article, for a case study or with a journalist

Freedom of information

In 2019, NRAS asked NHS England to look into this. They did, and published this clarification.

‘A policy adopted by a commissioner that would serve to limit patients’ access to appropriate treatments based on a number of prior treatments being attempted would be counter to the provisions of the NHS Constitution. The NHS Constitution pledges that patients have the right to drugs and treatments that have been recommended by NICE subject to being clinically appropriate, and patients have the right to expect local decisions on the funding of drugs and treatments to be made rationally and following the proper consideration of evidence. Clinical assessment of the appropriateness of treatments should be the overriding factor rather than the implementation of policies for cost saving reasons.’

We also invited health care practitioners who have experienced ‘three strikes and you are out’ to get in touch with You can share your experience in confidence, which will help NRAS to work with NICE and NHS partners to make sure nobody living with RA is told, ‘It’s three strikes and you are out!’