According to a statement by the New York–based Pfizer the price "is not the cost that most patients or payors pay" since most prescriptions are dispensed through health plans, which negotiate discounts for medicines or get government-mandated price concessions. In the United States specialty pharmacies fill prescriptions for drugs that are usually high cost. In February 2017, the National Institute for Health and Care Excellence (NICE) in the United Kingdom published a statement stating that the cost of Ibrance (approximately US$3700/28 days) did not make the added health benefits worth the cost. Though the committee acknowledged Ibrance's ability to extend patient life by approximately 10 months, it was stated that with the side effects caused by Ibrance, it was not a cost-effective medication for NICE to endorse. At the time, a year's treatment with palbociclib and a drug such as fulvestrant was priced at US$106,105 (£79,650). In November 2017 NICE announced that, after negotiation with Pfizer, the price would be discounted, and the drug would be recommended for use. Palbociclib has several direct competitors currently on the market or in clinical trials. In September 2017, abemaciclib, another selective CDK4/6 inhibitor owned and manufactured by Eli Lilly, was approved for HR-positive, HER2-negative advanced metastatic breast cancer both in combination with fulvestrant and as a monotherapy. In March 2017, the FDA also approved ribociclib, owned by Novartis, as a combination therapy with aromatase inhibitors for indications similar to those of palbociclib and ribociclib. Notably, ribociclib seems to also have an inhibitory effect on Cyclin D3/CDK6 activity. G1 Therapeutics also has a Cdk4/6 inhibitor, trilaciclib, which is currently in phase II trials, but as of December 2017 has not gained FDA approval. In Bangladesh it is under the trade name Palbonix.