Now that it has control of England’s Cancer Drugs Fund (CDF), NICE has been weeding out drugs it doesn’t consider worth their prices and thyroid cancer drugs from Sanofi and Ipsen are about to be plucked.

The National Institute for Health and Care Excellence said today in draft guidance that it was not recommending Sanofi’s Caprelsa or Ipsen’s Cometriq for routine use by the National Health Service. It said that while the drugs delay progression of advanced thyroid cancer, they may not actually prolong life and so are not cost-effective, despite discounts offered by the drugmakers.

NICE pointed out this is draft guidance, giving the drugmakers and others time to provide their input, and will take another look next month.

Sanofi has only had Caprelsa for a couple of years, having picked it up for about $300 million in 2015 in one of AstraZeneca’s quick sales to unload older meds to raise cash. The NICE decision may be a bigger hit for Ipsen, which agreed last year to license Cometriq from biotech Exelixis in a deal worth up to $855 million.

NICE took over management of the cancer fund in 2016 after cost overruns prompted authorities to take another tack. Since then, it has been evaluating the drugs that are covered and tossing some, and in some cases striking new deals with drugmakers. Whereas the CDF initially covered the costs of cancer drugs that NICE had decided to reject, now it will pay for some of them on an interim basis while drugmakers gather more evidence that they are cost-effective.

Last month, for example, NICE agreed to continue to pay for Roche’s blood cancer drug Gazyvaro for about 600 patients while authorities gather more data on its effectiveness against relapsed refractory follicular lymphoma. Roche also provided an undisclosed discount.  

But not all drugs get covered, and drugmakers have gotten more vocal in criticizing NICE’s decisions around when they don't. Pfizer complained loudly this week when the drug cost watchdog, in final guidance, rejected the drugmaker's new targeted treatment for the rare but deadly acute lymphoblastic leukemia. The drug won FDA approval just last week.

"Today’s frustrating decision for inotuzumab ozogamicin is another example of how NICE is not appropriately assessing the value of modern cancer medicines, leaving patients without access to new treatments that could transform their lives," Pfizer said in a statement.