> Sexual health is part of public health, and thus we'd expect PrEP to be funded by Public Health England, not the NHS.. The target of your anger here should b

> Sexual health is part of public health, and thus we'd expect PrEP to be funded by Public Health England, not the NHS.. The target of your anger here should be local authorities (who hold responsibility for Public Health), not the NHS. First, PHE and NHS are both part of the DH, as is NICE. Second, sexual health is one aspect of PrEP, but it's not the full picture (though of course, that's how the NHS press release you linked would be inclined to portray it. The lower court disagreed with that portrayal, even if the appeals court did not.) Finally, the arbitrary delineation of responsibilities in which the NHS is free to wash its hands off of the matter and NICE has no incentive to hold the NHS accountable - leaving patients with no choice but to pay out-of-pocket - is exactly the problem. Meanwhile, PrEP has been generally available (and essentially free) in the US for four years, thanks (ironically) to the federation of power which forces insurers to remain somewhat competitive with each other, and which permits the pharmaceutical companies to pick up the slack when that fails. If you want to point out that this approach has its shortcomings as well, then yes, I'm right there with you. But it's wrong to imply that what NICE and the NHS are doing is fundamentally different from the cost-benefit analyses done in the US, and it's also wrong to ignore the problems with the DH.