Firstly I'm only speaking about England. I don't know what happens in Wales, Scotland, or Northern Ireland. Clinical Commissioning Groups should be following N

Firstly I'm only speaking about England. I don't know what happens in Wales, Scotland, or Northern Ireland. Clinical Commissioning Groups should be following NICE guidance. If NICE looks at a medication and says it doesn't provide enough advantage for the cost they won't recommend it. That means CCGs won't always pay for it, and so hospitals can't use it. Sometimes when NICE recommends a treatment the patient has a legal right to it, and the patient can pursue treatment if their local CCG is trying to avoid paying for it. This cost:benefit calculation appears to be what's happening in the US. Except over here it's a public body making the decision and over there it's a private company. Here's the NICE page for Pomalyst: https://www.nice.org.uk/guidance/ta427 https://www.nice.org.uk/guidance/ta427 > Pomalidomide, in combination with low‑dose dexamethasone, is recommended as an option for treating multiple myeloma in adults at third or subsequent relapse; that is, after 3 previous treatments including both lenalidomide and bortezomib, only when the company provides pomalidomide with the discount agreed in the patient access scheme. That seems similar to the US? Only to be used after other meds have been tried, and only if the company supplies it at a previously arranged discount. (I didn't do much searching for this so maybe I've misunderstood the NICE guidance). https://www.nice.org.uk/corporate/ecd4 https://www.nice.org.uk/corporate/ecd4 > If NICE recommends the use of a treatment, the NHS Constitution says that it is your legal right to have it if your doctor believes it is right for you. https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england#patients-and-the-public-your-rights-and-the-nhs-pledges-to-you https://www.gov.uk/government/publications/the-nhs-constitut... > You have the right to drugs and treatments that have been recommended by NICE for use in the NHS, if your doctor says they are clinically appropriate for you. And here's a list of those treatments: https://www.nice.org.uk/guidance/published?type=hst,ta https://www.nice.org.uk/guidance/published?type=hst,ta