Can Novartis' Kisqali beat Pfizer's market-leading Ibrance to reimbursement in England?

Novartis’ Kisqali, the second-to-market med in the CDK4/6 class, is playing from behind. Pfizer's Ibrance is the fast-growing drug to beat, no question. But Kisqali (ribociclib) just may have a shot at being No. 1 when it comes to snagging reimbursement in England.

On Thursday, the Swiss drugmaker’s breast cancer drug won a European green light for use in tandem with any aromatase inhibitor. And Barak Palatchi, general manager of Novartis Oncology UK and Ireland, says the company is "working closely" with England’s cost watchdogs at the National Institute for Health and Care Excellence (NICE), "to ensure eligible patients in England and Wales have access to ribociclib at the earliest opportunity."

"The new NICE process to assess funding cancer medicines on the NHS is a welcome development," he said in a statement.

Now, Novartis has a shot to beat rival Pfizer to the punch. Despite the head start for the New York pharma giant’s contender, Ibrance—it won its EU go-ahead last November—Pfizer has so far come up empty in its efforts to win NICE backing.

That’s not to say Pfizer didn’t see it coming. Last year, a U.K. company executive predicted trouble with the cost-effectiveness gatekeepers. The way he saw it, the agency's methodology—which classified Ibrance, approved in combo with an aromatase inhibitor, as an "add-on" med—put the product in a poor position to gain coverage.

And indeed, in February, NICE nixed the med in draft guidance, citing the price—£79,650 ($99,392) for a full course of treatment—as too high for routine NHS use.

Kisqali, too, would be classified as an "add-on"—but a cheaper one. The med bears a lower list price than Ibrance does, at least in the U.S., and Novartis' flexible pricing structure for the med should give it "an ~18% to 20% lower aggregate cost based on the dosing seen in the trial," a company spokeswoman said following its March FDA approval.

Meanwhile, Pfizer is still hoping to turn its fortunes around. Final draft guidance isn’t due until the end of next month, and NICE has been known to change its mind when discounts are involved. In the meantime, the company has taken matters into its own hands, offering up Ibrance at no charge to women in the U.K.

"Pfizer believes women with metastatic breast cancer deserve access as soon as possible to this innovative medicine that has been shown to significantly increase progression-free survival," a spokeswoman said in May.