Sequential use of advanced therapies

Some Integrated Care Boards (ICBs) have been artificially restricting access to advanced therapies (biologics, biosimilars, JAK inhibitors etc.)


For some time, NRAS has been concerned that some Integrated Care Boards (“ICBs”) have been artificially restricting access to advanced therapies (biologics, biosimilars/JAK inhibitors) in England, and we undertook a Freedom of Information request to all Clinical Commissioning Groups (as they were at the time) back in 2019.

Our Patient Champion, Ailsa Bosworth, has been involved in a number of research papers on this issue. Most notably, Ailsa was involved in a research paper published in 2021 (main author: Dr. Arvind Kaul) regarding access to advanced therapies for patients with inflammatory arthritis: a postcode lottery? This paper explored the inequality in England of having access to advanced therapies and that patients were subjected to a “postcode lottery” for treatment pathways.

We understand that the pathways within ICBs remain in place to restrict access to advanced therapies. A number of NRAS members 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!’

We are now collaborating with the British Society for Rheumatology to agree a correct and uniform interpretation from clinicians and ICBs to address the disparity in access to treatment in some areas.

If you live in the UK and have experienced only being able to access a limited number of advanced therapies (possibly 3 or 4) that you could try to find a treatment that works for you, 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 ICB or Health Board you receive care from and let us know whether you would be willing to share your experience for use in an article, a case study or with a journalist.