Beginning in April of this year, NHS England will have the ability to withhold patient access to select approved medicines, according to The Times. Even if NICE considers a new drug of appropriate value, it may be withheld or rationed if it costs the NHS more than £20 million per year. While this might not be too alarming for those seeking help to lower cholesterol, the prospect of a drug being withheld for a rare disease – even if it is considered good value – is no bueno. Or what if one of the many potential Alzheimer’s drugs in development works? The size of the addressable patient population could make the £20 million threshold look puny. Stay tuned for more unpopular decisions to come.