Affording the ever-increasing cost of medicines is a struggle throughout the NHS. A College Working Party has addressed the issues in an extensive recent report(1) that analyses the cost of medicines, their licensing and evaluation, priority setting and its ethical and legal implications. It considers options for increasing the available resource, but explains why everyone concerned with the evaluation, funding and use of medicines must recognise the need to set priorities. Though the report does not pretend to have solved the problem facing the NHS, it describes many examples of good practice and suggests a way forward.