Sweeping changes to the Cancer Drugs Fund have raised the hackles of groups who fear that access to therapies will be compromised.
The new CDF regime gets underway on 1 July with a fixed budget of £340m - the same level as was set in 2015/16 - and decisions on access to medicines are now firmly in the hands of the National Institute for Health and Care Excellence (NICE).
The changes were agreed at NHS England's board meeting this week.
Few would argue that the CDF did not need reforming - it has been widely branded unsustainable in its present form after massively overshooting its budget and diverting funding away from other NHS services.
No patients currently receiving medications through the CDF will have their treatment stopped, according to NHS England, although it will be closed to new drugs until the start of the new scheme.
Thereafter, NICE will place cancer drugs in one of three categories - eligible for use on the NHS, ineligible or in a 'maybe' category that will be considered for inclusion in the CDF.
The Fund will have clear entry and exit criteria, however, so it is expected that new drugs will enter and leave the scheme as new therapies become available.
The Rarer Cancers Foundation (RCF) - which has already suggested that 23 out of the current 38 treatments currently available through the CDF will be cut under the new regime - says that more than 12,000 patients a year could lose out on treatment.
The changes "stop short of properly reforming NICE, whose decisions meant the CDF was necessary in the first place", according to RCF chief executive Andrew Wilson.
Meanwhile, the pharmaceutical industry has also expressed concerns about the new system, arguing that it effectively reverts to the system in place before the CDF was set up.
"If cancer medicines go through more or less exactly the same NICE appraisal process that was in place five years ago … we will largely get the same answers as before - the majority of medicines will be turned down," commented Paul Catchpole, value and access director at the Association of the British Pharmaceutical Industry (ABPI).
The ABPI estimates that under the forthcoming regime two thirds of existing CDF medicines are likely to no longer be available to NHS patients by the end of the year.
But NHS England refutes those claims, noting that NICE will be working with new appraisal methodologies and that companies have the opportunity to review their pricing levels with a view to either continue to receive CDF funding or gain approval for routine commissioning.
"Under these measures, patients will get faster access to the most promising new cancer treatments and tax payers will get better value from drugs expenditure," said NHS England in a statement.
"Drug companies will need to price their drugs responsibly and we make no apology for maintaining the pressure on this point on behalf of the public.”