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The report, released on Thursday, October 29, says these differences may be due to “unjustified variation” in patient access and avoidable barriers in the system.
Titled Analyzing the adoption of SMC-approved medicines in Scotland, the report was supported by analytics firm LCP Health and examined NHS prescribing patterns across all 14 Scottish NHS boards from September 2020 to August 2025.
It is the first study to compare different types of medicines in different regions in this way.
In Scotland, the Scottish Medicines Consortium (SMC) determines whether a new medicine is clinically effective and offers value for money.
Boards are expected to choose within 90 days whether to add it to their local list of drugs, known as formularies.
Victoria Jordan, executive director of patient access at the ABPI, said: “Scotland has a strong and respected system for assessing new medicines.
“But this report shows that the use of some accepted medicines can vary widely between NHS boards, and that differences in patient need do not fully explain this.
“Although the data we have does not tell us everything, it does show that we need to look more closely at this issue.
“If avoidable barriers slow things down, patients may have to wait longer than they should for medicines that are already judged to be effective and good value.
“We need to plan and work together across government, the NHS, clinicians, patients, academia and industry.
“That way, we can help ensure that national SMC decisions benefit patients, no matter where they live.”
The report found the greatest variation in access to GLP-1 drugs used to treat type 2 diabetes and, in some cases, for weight management.
At the end of the study period, the Western Isles NHS Board was prescribing these drugs at rates almost 10 times higher than the lowest prescribing board, Shetland.
This gap could not be fully explained by differences in diabetes and obesity prevalence.
In some areas, it took more than a year to add GLP-1 drugs to local formularies.
The report also identified significant variations in the prescribing of non-statin cholesterol-lowering drugs for patients at high risk of heart attack and stroke.
At the end of the study, prescribing rates differed by a factor of eight to 10 between the highest prescribing board, Highland, and the lowest, Forth Valley.
Boards in the west of Scotland generally had higher prescription rates than those in the east.
The report suggested that the organization of local services plays a key role.
Areas with stronger links between specialist lipid clinics and GPs tend to have higher prescribing rates.
However, the analysis did not adjust for differences in patient need or service provision.
The ABPI warned that many limitations in the available data restrict the conclusions that can be drawn and stressed that the report does not rank NHS boards or provide explanations for individual variations.
The report makes seven recommendations to the Scottish Government and NHS Scotland, including earlier planning to ensure services are ready before SMC advice is published, greater transparency around formulary decisions, and additional support for complex medicines that require specialist services.
Other recommendations include piloting protected funding for high-impact medicines and closer collaboration between government, the NHS, academia and industry.
The ABPI emphasizes the need for a “triple helix” approach to ensure that national decisions translate into real benefits for patients across the country.
