Faster uptake for drugs in an established class

In this article, we explore the data to understand why if a drug lands in a therapeutic class, the system already understands (the “follow‑on” / me‑too dynamic), it usually moves faster once approved. The reason is simple: the NHS, clinicians, and pathways already have the muscle memory. Guidelines exist, service lines are set up, monitoring is familiar, and the “where does this fit?” question has largely been answered in advance.

Launch data backs that up. Historically, first‑in‑class (“pioneer”) drugs have tended to climb more slowly than later entrants in the same class. One analysis found a pioneer took ~8 years to reach peak usage, while followers hit peak usage in ~3–4 years on average. When clinicians already know the mechanism and the system already has the infrastructure (protocols, monitoring, clinic routines), implementation friction drops. So if the new drug offers a clear advantage, better efficacy, fewer side effects, easier use, doctors can substitute or add it with minimal pathway disruption. Net result: faster uptake versus truly novel therapies, because the learning curve and service redesign are limited.

That said, being “in class” doesn’t guarantee momentum. A follow‑on still needs to prove its worth, clinically and/or economically, to displace what’s already embedded. If a me‑too offers no meaningful improvement, uptake can stall even if it’s a familiar category. But in general, when the asset slots neatly into an established paradigm, the NHS and clinicians can implement it relatively quickly.

This is also consistent with what the UK’s NICE Innovation Scorecard tends to show: rapid growth in use is often seen for incremental innovations. For example, newer diabetes medicines within well‑understood categories (such as next‑generation SGLT2 inhibitors following earlier drugs) have achieved broad uptake, while adoption of more complex innovations can be uneven. That pattern is exactly what you’d expect when “fit to pathway” is doing the heavy lifting.

Slower adoption of novel therapies that require new pathways

Now flip the situation. If the therapy is genuinely novel, new mode of action, new delivery model, new service configuration, companion diagnostics, implementation is typically slower. Not because the medicine isn’t valuable, but because the system has to change to use it at scale. Approval is the starting gun, not the finish line.

NHS and NICE analyses have repeatedly flagged uptake of innovative treatments as “stubbornly variable” across regions, and a lot of the underlying drivers are structural: you can’t prescribe what you can’t identify, deliver, fund, staff, or route through a workable pathway.

Key reasons implementation can lag for novel therapies:

Diagnostic requirements

Some cutting‑edge drugs only work for patients with specific biomarkers, which means the diagnostic pathway becomes the rate‑limiter. NICE’s appraisal of larotrectinib is a good example: identifying patients with rare NTRK gene fusions implied broad genomic screening that wasn’t routine in the NHS. NICE explicitly treated the diagnostic pathway as crucial, noting that finding eligible patients would require significant new testing efforts. NHS England subsequently established a national genomic testing service with 7 lab hubs to screen tumours for these mutations; until that infrastructure was in place, the pathway for using larotrectinib was described as “uncertain.” Put bluntly: a therapy tied to a novel diagnostic can only diffuse as fast as the system can roll out the test.

Specialised delivery and infrastructure

Cell and gene therapies (and other advanced modalities) don’t just add a new prescription—they create new delivery requirements. CAR‑T illustrates this well. The NHS introduced CAR‑T starting in 2018 and expanded to 14 specialist centres by 2022, which is fast by historical standards. Even so, access has remained constrained by geography and capacity, with analyses showing significant regional variation in uptake because provision is concentrated in specialist sites. More broadly, official reviews point out that adoption of complex medical technologies is often perceived as slow due to the “process re‑engineering often required to support implementation.” If the therapy doesn’t layer onto an existing pathway, the system has to reorganise services and invest in capability—and that takes time.

Pathway and workforce challenges

First‑of‑its‑kind therapies typically mean new referral steps, monitoring regimes, follow‑up routines, and governance. The NHS Confederation highlights capacity constraints in developing pathways and the administrative burden that can slow rollout. Clinicians and MDTs need training; guidelines need updating; teams need confidence managing the new approach. Add in the “rigidity in pathway structures” (where patients must fail older treatments before an innovative option is tried) and you get a predictable effect: adoption slows until pathways are redesigned and experience accumulates.

Initial funding and policy hurdles

Novel interventions don’t always fit existing commissioning/payment frameworks. Some require new funding routes or additional approval processes (and it’s worth remembering that devices recommended by NICE don’t automatically receive funding in the way medicines often do). The Accelerated Access Review highlighted barriers like a “disconnect between what the system wants and the development of new products,” and the need for deliberate effort to align incentives and routes to market. Until that alignment is solved—via adoption programmes, innovation funds, or commissioning updates—uptake can lag even with strong evidence.

The practical rule: the more disruptive the innovation is to existing practice, the longer implementation tends to take.

NICE Innovation Scorecard data and wider NHS research broadly support that. Many NICE‑approved innovations show gradual or uneven uptake, especially when infrastructure or process change is required to use them effectively. By contrast, if a new drug can be plugged straight into an established care pathway, adoption is usually faster and more uniform.

To be clear: the NHS can move quickly when the clinical imperative is overwhelming or the system is mobilised (COVID‑19 vaccines are the obvious example; curative Hepatitis C therapies also achieved rapid movement). But under typical conditions, the pattern holds: incremental innovations diffuse more readily, while radical innovations face more initial friction because diagnostics, delivery, services, and pathways need time and investment to catch up.

Evidence from NICE’s Innovation Scorecards

NICE’s Innovation Scorecard exists to track how well NICE‑recommended medicines and technologies are being adopted across the NHS. The scorecards do show that, over time, the system integrates new treatments: a majority of medicines on the scorecard demonstrate year‑on‑year growth in usage (for example, over 75% of tracked medicines saw increased prescribing in the past year).

But the scorecard is also very clear on the less comfortable truth: uptake can be “stubbornly variable” across regions and care settings, and those variations translate directly into uneven patient access. Some of the widest gaps appear where the innovation depends on novel diagnostics or specialist input. For example, in diabetes, when comparing uptake of different medicines (including newer classes versus older ones), there was over a 50% variation between NHS trusts in usage rates. That kind of variation is exactly what you see when pathway readiness, local capacity, and implementation grip differ.

The recurring theme is infrastructure + pathway readiness. Where clinics, skills, and funding streams already exist, NICE guidance converts into uptake quickly. Where guidance effectively means “build a service” (advanced therapies, diagnostic‑dependent treatments), uptake is slower even with positive recommendations. NHS leaders have been candid about this: approval alone doesn’t implement anything—system alignment does. That’s why mechanisms like NHS England’s Accelerated Access Collaborative and innovation funds exist: to tackle structural adoption barriers, not just evidence gaps.

Conclusion

So the hypothesis holds up in the real world: existing‑class drugs generally adopt faster because they slot into established pathways with minimal disruption, while ground‑breaking therapies often adopt more slowly because the NHS needs time to build diagnostics, delivery capability, commissioning routes, workforce confidence, and redesigned pathways.

Easy takeaways

• If it’s “in class,” adoption is usually faster because the pathway already exists and clinicians already know how to use it.

• If it’s truly novel, the bottleneck is rarely the medicine—it’s diagnostics, delivery infrastructure, workforce readiness, and commissioning fit.

• Variation is the tell: where adoption is uneven across regions, it often points to local pathway/infrastructure constraints rather than clinical doubt.

• Implementation planning is a competitive advantage: the earlier you map the required pathway change, the faster you can compress time‑to‑impact.

If you’re trying to understand what this means for your asset; forecasting uptake curves, identifying the real constraints (diagnostic? site capacity? pathway rules? funding route?), and translating “approval” into “access”, that’s exactly where nzyme is useful. Engage with us to get a clearer, sharper read on your market dynamics and what will actually drive (or block) adoption in practice.