In a stark reminder of the postcode lottery of care that exists in the UK, it is looking likely that patients with chronic plaque psoriasis patients in England and Wales will not be getting NHS access to Celgene’s Otezla while those in Scotland will.

Draft guidelines from the National Institute for Heath and Care Excellence out this morning (Wednesday) do not recommend Otezla (apremilast) for patients with moderate and severe psoriasis on ground that its cost failed to fall within the range considered to be a cost-effective use of NHS resources.

The news will be particularly disappointing to the firm and psoriasis patients given that, just two days ago, the Scottish Medicines Consoritum bcked the drug’s its use for adults who have failed to respond to or can’t take other systemic therapy.