For the second time, the UK agency that monitors the cost effectiveness of medicines has decided that a Roche breast cancer drug is too expensive. The decision means that the UK’s National Health Service will not cover the $137,000 per patient cost of the drug for women in Scotland and Wales. However, Roche struck a separate deal so that a special government fund will foot the bill for women in England.

“We recognize that Kadcyla has a place in treating some patients with advanced breast cancer, and we have been as flexible as we can in making our recommendation,” said Andrew Dillon, the National Institute for Health and Care Excellence chief executive, in a statement. “However, the price that the manufacturer is asking the NHS to pay in the long-term is too high.”

The decision underscores the growing friction between payers and drug makers over perceived values in an era of tightening government budgets. Prescription drug pricing, of course, is a topic of national debate in the US and has become fodder for the presidential campaign. A recent Kaiser Family Foundation poll found that 63 percent want government action to lower drug prices.

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In Europe, the UK’s NICE has taken the lead in assessing the value of medicines, and has often sparred with the pharmaceutical industry as a result. Over the past few years, NICE has regularly rejected drugs based on cost. Some drug makers have occasionally responded by offering to lower prices.

But Kadcyla has generated particular attention, in part, because NICE harshly rebuked Roche last year over the cost of the medicine and because patient groups similarly chastised the drug maker. Thousands of people later signed an online petition urging Roche to lower the price. A survey conducted earlier this year found that just 14 percent of patient groups in the UK believe drug makers have done a good or excellent job in pricing their medicines fairly.

For its part, Roche recently offered a discount so that the National Health Service could offer the treatment to women in England through the Cancer Drugs Fund. This was created by the government to pay for medicines that are considered to be too expensive under the usual coverage mechanism. Kadcyla was on a list of drugs that were to be cut from the fund due to cost.

But the drug maker did not offer a similar discount so that the NHS could also provide the treatment to women in Scotland and Wales. It is not clear if Roche will challenge the guidance, but the company has retained former UK health secretary Andrew Lansley to navigate the dispute. We asked the drug maker for comment and will update you accordingly.

“We need a unified approach, and, moving forward, it is imperative that we work together to build a pragmatic, flexible and sustainable system for assessing medicines that prioritizes clinical value,” the company said. “Only then will we be able to ensure the best outcomes for people with cancer in the UK.”

Patient groups, not surprisingly, are disappointed.

“We simply cannot continue in this way, with highly effective new cancer drugs being held just out of reach for patients in certain areas of the UK,” said Caitlin Barrand, assistant director of policy and campaigns at Breast Cancer Now, a leading patient group.

“It’s time that the prime minister showed real leadership on this issue,” Barrand continued. “People living with incurable cancer don’t have time to lose, and a fairer, more flexible system that enables access to the best treatments available on a routine, UK-wide basis is long overdue.”

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