Gov't Planning Major Overhaulof Health Basket

Subsidized health care to include new, more expensive treatments that are intended for fewer patients.

The committee in charge of subsidized health care yesterday said it would include 77 new medications and cutting-edge medical treatments in next year's health care package, dubbed "health basket."

The decision came after 600 requests were submitted for new medicines, at a cost of over NIS 2 billion.

pill, medicine, tablet -  Bloomberg - sourced 25.12.11

"Unlike previous years, in which the committee chose mainly treatments intended for a large number of patients, this time we included more expensive medicines intended for a smaller number of patients in the subsidized package," a senior health official said at a press conference yesterday.

The list includes 77 drugs earmarked for some 30,000 people for a total of NIS 300 million. After the list is approved by the Health Council and cabinet the drugs are expected to be available from next week.

In contrast, last year the subsidized package included 52 drugs and treatments for 230,000 people and the previous year it included 80 drugs and treatments for 100,000, including quit-smoking workshops. Three years ago the package included 83 drugs for 340,000 patients.

"It's not easy to be a member of the committee for subsidized health care," said Deputy Health Minister Yaakov Litzman. "You have to make decisions what's important and what isn't important, and even the decision about what remains out [of the package] is made after complicated discussions. The budget is limited, but even if we have a billion shekels for the package some medicines would still be excluded."

Most of the drugs and technologies in the subsidized health care are new, but some of them were already in it. The committee added 22 medicines to the package at no additional cost to the patient, as an extra treatment to the existing ones.

"This year's package is characterized by the large number of medicines in it," said Health Ministry Director General Roni Gamzu at the news conference.

"This is due to our efforts vis-a-vis the drug companies to keep costs to a minimum and include more treatments," he said.

For each of the past three years the NIS 6.7-billion budget for subsidized health care was augmented by NIS 300 million. Legislation proposals stipulating a permanent annual 2 percent increase in the subsidized health care budget were rejected by the Knesset in recent years.

The Society for Patients' Rights in Israel has blasted the low budget allocated for subsidized health care in recent months. A society activist said "the low budget means most patients will once again remain without the medicines and treatments they need."

Litzman, who objected to the legislation proposal to fix the subsidized health care budget, said "if I allocate money for the basket or other causes, I won't have liquid funds left. The Health Ministry's job is to see what's important and the agreements with the Finance Ministry contain many clauses. The bottom line is, maintaining a [fixed] budget for subsidized health care will harm other goals."

The most expensive medicines in next year's health basket are Yervoy and Zelboraf, two medicines used to fight skin cancer, constituting a medical breakthrough that may lengthen the average patient's life by up to six months. The treatment is intended for 162 Israeli melanoma patients per year and costs between NIS 262,100 and NIS 369,700 per patient. The two medicines cost more than a fifth of the entire subsidized package, totaling NIS 46.6.

Three separate treatments that help fight AIDS are also to be included in next year's basket.

The especially high-cost treatments in the package include Soliris, intended for eight patients suffering from a rare kidney disease at an annual cost of NIS 1.9 million per patient; Carbaglu for the metabolic disturbance Hyperammonemia, intended for only two patients at an annual cost of NIS 1.2 million per patient and Orfadin, for hereditary tyrosinemia type 1, intended for 17 patients at an annual cost of NIS 520,000 per patient.

However, the basket leaves out Nuchal scans for pregnant women, as well as amniotic fluid tests for women over 35. The antidepressant Cipralex was also left out of the list, as the committee decided that it was not as effective as other similar psychiatric treatments.

The committee revoked the health insurance deductible sum of NIS 1,390 for the medicine Decapeptyl, a chemical castration inhibiting sex hormones, intended for pedophiles who couldn't use it due to its high cost, intended for an estimates 100 Israelis a year.

The committee approved the use of Gilenia for multiple sclerosis patients, an oral treatment that can replace traditional injections in some cases.

This year's package also includes Arbitox, a medication used to treat intestinal cancer.