The National Institute for Health and Clinical Excellence is to proceed with controversial plans to broaden access to drugs for terminally ill people.
The move comes in the face of serious concerns from health managers.
NICE has given its backing to supplementary evidence on end of life drugs for rarer conditions, despite fears of increased financial pressures on primary care trust drug budgets.
The supplementary advice to technology appraisal committees will apply to treatments licensed for "terminal illnesses affecting small numbers of patients" that were more expensive than the current£30,000 a year limit.
Last month the NHS Confederation warned in its response to NICE's consultation on the change that anything from 13 to 178 patients per PCT could become eligible for costly treatments not previously funded.
It also warned that less cost-effective medicines could end up being prioritised over more effective treatments that did not undergo NICE evaluation.
NICE chief executive Andrew Dillon said the institute was "conscious of its responsibility to support the development of novel treatments for smaller patient groups".