The Association of the British Pharmaceutical Industry (ABPI) has announced that negotiations with the UK government regarding revisions to the 2024 Voluntary Scheme for Branded Medicines Pricing, Access, and Growth (VPAG) have ended without agreement. The mid-scheme review, initiated in April 2025, sought to address rising payment rates under VPAG, which currently require pharmaceutical companies to return between 23.5–35.6% of their NHS sales revenue significantly higher than rates in comparable countries. Despite collaborative efforts, no consensus was reached on reforms to reduce these rates or to update the valuation methods used by NICE, which have remained unchanged for nearly 25 years. The failure to resolve these issues threatens the UK’s ambitions for life sciences growth, patient access to innovation, and international competitiveness.