4.1 When NICE recommends a treatment as an option for use within the Cancer Drugs Fund, NHS England will make it available within the conditions of the managed access agreement. This means that, if a patient has locally advanced or metastatic urothelial carcinoma that has previously been treated with platinum-containing chemotherapy and the doctor responsible for their care thinks that pembrolizumab is the right treatment, it should be available for use, in line with NICE's recommendations and the Cancer Drugs Fund criteria in the managed access agreement. Further information can be found in NHS England's Appraisal and Funding of Cancer Drugs from July 2016 (including the new Cancer Drugs Fund) – A new deal for patients, taxpayers and industry.
4.2 The Welsh ministers have issued directions to the NHS in Wales on implementing NICE technology appraisal guidance when the drug or treatment, or other technology, is approved for use within the Cancer Drugs Fund. When a NICE technology appraisal recommends the use of a drug or treatment, or other technology, for use within the Cancer Drugs Fund, the NHS in Wales must usually provide funding and resources for it within 2 months of the first publication of the final appraisal determination or agreement of a managed access agreement by the NHS in Wales, whichever is the latter.
4.3 Pembrolizumab has been recommended according to the conditions in the managed access agreement. As part of this, NHS England and Merck Sharp & Dohme have a commercial access agreement that makes pembrolizumab available to the NHS at a reduced cost. The financial terms of the agreement are commercial in confidence. Any enquiries from NHS organisations about the commercial access agreement should be directed to firstname.lastname@example.org.