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In a rare move, the Dutch health ministry refused to provide coverage for a Gilead Sciences breast cancer treatment in a dispute over cost, one of the few times the government agency has taken such a step in recent years.

In explaining the decision, Health Minister Ernst Kuipers maintained that the price Gilead sought to charge for its medication, known as Trodelvy, did not justify the health benefits. The cost for each of the estimated 139 people who would be eligible for treatment would have been approximately $74,465, or a $10.4 million annual outlay.

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Concerned over the expense, the National Health Care Institute, which advises the health ministry, last year assessed the Gilead drug and concluded the medicine would only be cost-effective if the price was lowered by 75%. But the company “proved unwilling” to offer such a discount, according to the health ministry.

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