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A Brazilian government advisory committee recommended that the health ministry not pay for a cystic fibrosis treatment made by Vertex Pharmaceuticals after deciding the drug is not cost-effective, the latest clash over access to the pricey but groundbreaking medicine.

The decision by the National Committee for Health Technology Incorporation, also known as Conitec, is not final, because a protracted public consultation will still occur over the drug, called Trikafta. The treatment is a combination of three Vertex medicines and is effective in treating roughly 90% of people with cystic fibrosis, which severely damages the lungs and greatly limits life expectancy.

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Nonetheless, the move underscores the difficulty Vertex is encountering in low and middle-income countries where its pricing has been criticized, an issue that has prompted patients in Brazil and elsewhere to take unusual steps in hopes of lowering the cost. In Brazil, the company is seeking to charge $126,000 per patient annually, according to advocacy groups.

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