Cladribine is the first disease modifying treatment (DMT) for relapsing remitting multiple sclerosis (RRMS) that progressed straight to a positive final recommendation in the NICE appraisal process. The final recommendations were published in December 2017.1 An agreement between NHS England and Merck, the manufacturer of cladribine (Mavenclad), will allow MS patients who are suffering from highly active or rapidly evolving RRMS to access the drug. Here, the authors discuss the clinical and economic considerations for cladribine usage.