Drugs that help smokers quit the habit are among the approximately 80 new medications and medical treatments included in the list of state-subsidized drugs for 2010, the selection committee recommended yesterday. Most of the 425 drugs submitted for approval, including the breast cancer drug Avastin, were cut from the list.
Some 70,000 people will benefit from the medications, including some 6,000 smokers who will now be able to kick the habit with the help of Zyban and Champix. Inclusion of those drugs costs the state NIS 6.6 million.
Selection committee chairman Professor Rafael Beyar commended the committee’s decision to introduce anti-smoking drugs into the subsidized services.
“The process of getting over smoking is of public importance and can save many more years of sickness than an expensive oncological medicine,” he said. The 80 new drugs are estimated at NIS 353 million, NIS 3 million more than the budget at the committee’s disposal.
The recommendations, which were submitted to Deputy Health Minister Yaakov Litzman yesterday, will go into effect only if they are first approved by the National Health Council, which Litzman heads, and then by the cabinet. The health council is expected to decide next Wednesday.
The drugs on the finalized list are expected to be available to patients on or about January 5.
Beyar said his selection committee rejected most of the 425 proposed medications.
“Most of the drugs submitted to the committee were left out of the list,” he said.
He said funding for all the proposed drugs would have come to more than NIS 1.5 billion, but that the committee had a budget of only NIS 350 million after the deduction of NIS 65 million for children’s dental care.
During the dramatic final debate on Tuesday night, the committee added NIS 300 million worth of drugs to the list of subsidized services. In the last hour the committee had to decide which of 10 drugs, at a cost of NIS 100 million, to select with the remaining NIS 50 million budget.
At that stage the committee struck off the list Avastin, a preliminary treatment for metastatic breast cancer patients. The treatment was intended for 250 patients annually and was the most expensive drug on the committee’s list, costing NIS 232,800 a year.
Since the committee had already decided to include other breast cancer drugs in the list, it decided unanimously to remove Avastin, a committee member said.
The committee also decided not to recommend subsidizing docetaxel (Taxotere) for the treatment of advanced stomach stomach cancer, a drug that prolongs patients’ lives by between two and four months. This medicine, intended for 400 patients a year, was graded fourth on the oncologists’ list of priority drugs.
Actemra (tocilizumab), a new biological therapy indicated for the treatment of rheumatoid arthritis in children and adults, was also struck from the list. It had been earmarked for 150 patients a year, at a cost of NIS 11.4 million. That medication was rated most important by rheumatoid arthritis specialists.
Another drug that did not make the final cut was Maraviroc, also known as Selzentry, which blocks the HIV virus from entering human cells. It was intended for 75 patients in advanced stages of AIDS, and would have cost NIS 2 million.
Committee members said another AIDS medicine had previously been added to the list of recommended drugs.
A committee member urged treasury officials to provide the NIS 3 million required to subsidize everything on the final list, but they refused. After intensive negotiations, the health maintenance organizations agreed to put up the required sum.
“I find it unacceptable that they deducted NIS 65 million from the committee’s budget to allocate to detal services, but can’t find NIS 3 million to complete the list of required drugs,” the committee member said.
The drug Kuvan, which controls phenylalanine and is used to treat the genetic disease phenylketonuria, which can lead to autism, mental retardation and various physiological disorders, was also removed from the list at the last moment.
The drug, manufactured by Merck Serono, was intended for treating 20 patients at an annual cost of NIS 4.7 million. However, due to the HMOs’ protests that the number of patients could turn out to be higher, the committee opened negotiations with the Merck Serono’s representatives in Israel.
The Health Ministry said Merck Serono agreed to finance the drug for patients above the 20-person quota for a few years. But when the ministry sent the company a copy of the agreement, it refused to sign it and the drug was left out of the list.
“To our regret, the patients will not receive the medicine because the company did not agree to the terms, although the ministry agreed to pay for the additional patients after five years,” Yoel Lipschitz, the Health Ministry’s HMO supervisor and a member of the committee, said yesterday.
“I’m sorry for the patients and hope the drug will be brought to discussion again next year with accurate figures of patients,” he said.
Merck Serono’s Israel branch denied the charges.
“This is the only company in the world that invests resources in developing medicine for the serious, incurable disease phenylketonuria,” the company said. “The company is astonished at the way the committee chose to present the facts and the inaccurate details it used. The drug company does not determine the number of patients who receive the drug. Doctors do that.
“Although the committee approached Merck Serono in the evening, at the last moment the company agreed to finance every additional patient above 15 new patients over a period of three years. The company never reneged on the agreement and regrets to say that the committee rejected this generous offer out of hand. We are at a loss as to why the committee decided not to meet the 20 patients half way. Especially if it cares about the patients’ welfare.
“Had the committee acted properly and approached the company in advance, we would surely have come up with a solution to provide medication for this severe disease.”
source: www.haaretz.com
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