A quadrupled bill, a shrinking antibiotic and a stalled blockbuster.

Every month we read the new NHSBSA release across the molecules we track and pick out what moved. April 2026 was generous. Three molecules, three completely different kinds of movement, and none of them visible from a single month's numbers alone.

The apixaban bill quadrupled, quietly

Flat items with a tripling unit cost is a price story, not a demand story. And it is not the standing price: the July Drug Tariff lists 56 apixaban 5mg tablets at £1.05, and an average item is almost exactly one such pack. When pharmacies are being reimbursed well above Tariff, the usual machinery is the price concession list, the monthly mechanism that tops up reimbursement when the market cannot supply at the listed price. We treat that as the working hypothesis rather than the verdict; what the open data shows beyond doubt is the bill.

Scale is what makes this matter. Apixaban ran to 11,107,302 items in the 12 months to April, and it now takes 50.5% of all oral anticoagulant items in England. On a molecule that size, a few pounds per item is millions per month of NHS spend, and a commercial question for every generic manufacturer in the market. The market is thoroughly generic, too: 974,300 of April's items were written generically, against 2,326 dispensed as originator-brand Eliquis.

The usual caveat carries extra weight here: these figures are net ingredient cost, the list price of what was dispensed, and items count prescriptions rather than patients.

Amoxicillin is still shrinking

The interesting part is the breadth. Every one of the ten highest-volume ICBs prescribed less amoxicillin than a year earlier, with declines running from 11.7% in North East and North Cumbria to 17% in Central East. When a fall is that uniform, it is stewardship policy working rather than local noise.

Meanwhile the July Tariff nudged most amoxicillin packs upward: 500mg capsules, three quarters of the market, went from 85p to 93p for a 15-pack. Falling volume with creeping unit prices is the late chapter of generic economics, and the sugar-free 250mg/5ml suspension jumping from £1.21 to £1.78 suggests at least one corner of the market is already strained.

Semaglutide stopped growing

The mix is worth a look. Ozempic pens carry about 31% of items and Rybelsus tablets around 24%, but a further 11.6% of items are written as plain semaglutide tablets. Nothing generic exists to dispense against those scripts, so the pharmacy hands over Rybelsus regardless; the habit costs nobody anything today, and it is exactly the prescribing behaviour that will matter on the day exclusivity ends.

The deprivation shape is the one chart we would put in front of a market access team: practices in England's more deprived areas dispense roughly three times more semaglutide per 1,000 patients than the least deprived, which is the gradient type 2 diabetes prevalence predicts. The honest limit, as ever: open data does not record indication, so diabetes and weight-management prescribing sit together in one number, and the shortage months of recent years still dent the series.

Three movements, one lesson

The five-year trend, cost per item and regional picture for every molecule here is free to read: apixaban, amoxicillin and semaglutide each have a page. If one of them is your molecule, we track it like this every month, briefing PDF included.

Source: NHS Business Services Authority, English Prescribing Data and Secondary Care Medicines Data, to April 2026, used under the Open Government Licence v3.0.

Written by the Cooply Solutions team. Corrections welcome at hello [at] dosetrend [dot] com.