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6 July 2018
      Roche’s Ocrevus (ocrelizumab) may be the only approved treatment for primary progressive multiple sclerosis, a tough-to-treat form of the disease. But regardless, England’s cost watchdogs still aren’t going to pay for it—that is, until it gets cheaper.

      Friday, the National Institute for Health and Care Excellence (NICE) shot down the drug for routine NHS use, citing price as the reason. “The most plausible cost-effectiveness estimates for ocrelizumab compared with best supportive care alone are much higher than those NICE normally considers an acceptable use of NHS resources in all scenarios presented by the company,” the body said in draft guidance.

      Last March, when Ocrevus nabbed its green light in the U.S., Roche said it would roll out the drug at a price of $65,000 per year, representing a 25% discount to Merck KGaA rival Rebif and a 20% discount, on average, to other MS therapies. Roche designed the price break to entice payers and put the squeeze on competitors like Rebif, a drug Ocrevus topped in clinical trials.

      But in England, NICE wasn’t impressed with Ocrevus’ £4,790-per-300 mg price tag, even with a confidential discount that Roche offered up.

      Of course, the gatekeeper can still change its mind if Roche can shrink Ocrevus’ price to its liking, and as industry watchers saw last week, it’s likely to do just that. After rejecting Ocrevus in relapsing remitting multiple sclerosis, NICE quickly came around on the drug after price negotiations, but with stipulations. NICE said that it would only recommend the product in patients with active disease for whom Sanofi’s Lemtrada isn’t an option.

      Roche, for its part, has clashed with NICE on plenty of its decisions outside the MS arena, too—particularly in oncology, where the pharma giant’s pricey therapies have faced their fair share of initial rejections. Most recently, NICE earlier this month declined to endorse breast cancer medication Perjeta, in combination with Roche’s Herceptin, in postsurgery patients with early breast cancer.