England’s medicines watchdog has approved Enhertu, a breast cancer drug it rejected two years ago, in the first major decision since the UK increased cost-effectiveness thresholds as part of its pharmaceutical deal with the Trump administration.

In a fresh deal with Astra Zeneca and Daiichi Sankyo, Enhertu will be available on the NHS to about 1,000 women a year with advanced breast cancer. Ministers said the decision showed the value of softening NHS value-for-money rules in exchange for exemptions from tariffs threatened by President Donald Trump. Nice now approves treatment costing less than £25,000-£35,000 per year of good-quality life, up from £20,000-£30,000.

Enhertu has been approved in Scotland since 2023 for metastatic HER2-low breast cancer that returned after chemotherapy. Yvette Cooper called it “life-changing”, while Helen Knight said a commercial solution and revised Nice methods enabled NHS access. MPs including Dame Chi Onwurah, Liam Byrne and Layla Moran asked the National Audit Office to examine the deal’s long-term costs, expected to reach £1bn over three years. Astra Zeneca did not immediately respond.