Medicines: How do we pay for innovative drugs?
A pot of money to give cancer patients access to expensive, life-extending drugs is about to get controversial.
The Cancer Drugs Fund in England is certainly popular with patients - too popular, in fact.
This week it will be culling some of the drugs it funds because it is cruising towards a £100m overspend.
The move has already angered some, raised questions about how the NHS pays for innovative new drugs and led to calls for the fund to be scrapped entirely.
The National Institute for Health and Care Excellence (NICE) approves drugs for widespread use in the NHS.
It is prepared to fork out up to £30,000 for a course of drugs to extend life by a year (adjusted to take account of the quality of life achieved).
It will pay around double that for "end-of-life" drugs including those for cancer.
Yet the latest wave of cancer medicines are coming with hefty price tags, some costing £100,000 per quality-adjusted life year (to use the technical jargon).
In a moment of election campaigning in 2010, the now Prime Minister David Cameron proposed a Cancer Drugs Fund, a £200m-a-year pot of money to pay for these super-expensive drugs.
The fund was supposed to expire last year, but has been extended until 2016.
It has been great for eligible patients. Around 55,000 have used the scheme; some will have gained months or even years of life through drugs which the NHS could never normally afford.
Yet it divides loyalties, as Dr Mangesh Thorat, a cancer doctor at Queen Mary University of London, has argued:
"This issue presents me with a dilemma - as a cancer clinician, I am happy that this Cancer Drugs Fund prevents my patients from being denied treatments towards the end of their life.
"However, on the other hand I think this fund not only undermines NICE but also discriminates against patients in similar situations who have diseases other than cancer."
The Cancer Drugs Fund is about to introduce price-caps on the drugs it will fund.
The pharmaceutical industry has already been told some of their drugs - including Jevtana, Zaltrap and Halaven - are being pulled as a result.
There will inevitably be outrage in some quarters when the announcement - expected Monday or Tuesday - is made.
The Association of the British Pharmaceutical Industry has already said it would "deplore any decision to restrict or remove patient access to cancer medicines".
Yet there is a much more fundamental conundrum that needs addressing.
The Cancer Drugs Fund is a sticking plaster - it exists because the old system no longer works.
So how does the industry make a profit (out of drugs that are often taken for just a few months) while the NHS gets a price it can afford?
Breakthrough Breast Cancer describes the Cancer Drugs Fund as "a short-term fix for a long-term problem" adding that "the long-term solution is now long overdue".
All eyes are on the government's "Innovative Medicines and Medical Technology Review" which is expected to report before the Autumn.