Charities have criticised the rejection of a drug that can extend the life of patients with secondary breast cancer for routine use within NHS Scotland.
The decision by the Scottish Medicines Consortium (SMC) not to recommend everolimus, also known as Afinitor, was described as a "shattering blow" to women living with incurable breast cancer.
The SMC, which reviews newly licensed medicines, has accepted six new drugs but said it was unable to recommend everolimus because the company that submitted it "did not present a sufficiently robust economic analysis".
Breast Cancer Now said it was "extremely concerned" that the drug was the fourth for secondary breast cancer to be rejected by the SMC since the introduction of its Patient and Clinician Engagement (Pace) process last year.
The system aims to improve patient access to new medicines for the treatment of end of life and very rare conditions.
Director for Scotland Mary Allison said: "The SMC's decision to reject Afinitor is yet another shattering blow to women across Scotland who are living with incurable breast cancer.
"When it comes to accessing high cost, innovative medicines for secondary breast cancer, the system is failing women in Scotland.
"Pharmaceutical companies need to get around the table with politicians to make more drugs available for women with secondary breast cancer now."
Nicolas White, head of Scotland at Breast Cancer Care, said: "Yet again women in Scotland living with incurable secondary breast cancer have been failed - everolimus is the fourth drug they have been denied in the past year.
"This devastating decision also creates a UK-wide postcode lottery, given the medicine is available in England and Wales, but not Scotland."
The recommendation of abiraterone (also known as Zytiga) and radium-223 (Xofigo) for men with incurable prostate cancer was welcomed by Prostate Cancer UK.
Scotland is now the only part of the UK where the drugs are routinely available both before and after chemotherapy and the charity wants England, Wales and Northern Ireland to follow suit.
Heather Blake, director of support and influencing, said: "Now that the correct decisions have been made, health boards must waste no time in ensuring that men who need these treatments can access them as soon as possible.
"Men with incurable prostate cancer should not be subjected to any further delays at a stage in their life when time is at an absolute premium."
The acceptance of the life-extending stomach cancer drug trastuzumab (Herceptin) was also hailed as a victory for patients.
Kate Cunningham, campaign director at oesophageal cancer charity Ochre, said: "The approval of Herceptin by the SMC today is extremely positive news for Scottish patients with this rare and incurable type of gastric cancer."
Russell Petty, professor of medical oncology at the University of Dundee, said the treatment was a "genuine breakthrough" in the treatment of gastric cancer.
The SMC also approved nintedanib (Ofev) for the lung condition idiopathic pulmonary fibrosis, ciclosporin eye drops (Ikervis) used to treat the severe inflammation of the cornea caused by dry eye disease and insulin degludec / liraglutide (or Xultophy) for diabetes.
Professor Jonathan Fox, chair of the SMC, said: "We are pleased to be able to accept these six medicines for routine use by NHS Scotland, four of them through our Pace process. This brings the number of medicines accepted through Pace to 23.
"However, uncertainty about the clinical benefits of everolimus meant we were unable to accept it.
"We know this decision will be disappointing to both patients and clinicians as we understand the devastating impact of breast cancer."
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