Health Min. Memo: New Meds to Cost Double the Budget

The costs for new medications defined by the Health Ministry as essential for hundreds of thousands of patients is expected to be roughly double the sum allocated for them, according to senior Health Ministry officials.

The costs are expected to run more than NIS 600 million, but the addition to the 2008 budget to upgrade the health basket, as agreed between the health and finance ministers in August, is only about NIS 300 million.

The information, contained in internal Health Ministry documents, was given to the members of the health services basket committee which will decide in the coming months which new drugs will be added to the basket.

In over 1,000 pages, the documents identify the priority of 78 medications as "essential" in saving or prolonging life, among them in cancer of the brain, the large intestine, blood, skin, prostate, breast, uterus, bone and others, as well as diabetes, heart and kidney disease, AIDS, growth disorders and others. The estimated cost of these medications is NIS 530 million. This figure is not final; with regard to approximately 20 of the essential medications, the document says final data is not in on the number of patients needing them and their costs. Thus the senior officials estimate the final cost of these essential medications will reach NIS 600 million.

The public health basket includes all state-funded medications, treatments and technologies given to all citizens as required by the National Health Insurance Law through the four Health Maintenance Organizations. The annual cost of the basket is approximately NIS 25 billion, however each year it must be upgraded to include new medications and technologies or new uses for existing ones.

The health basket committee, established at the beginning of the year is headed by Professor Menachem Fainaru.

The senior officials note in the document that the shortfall of NIS 300 million will lead to a wave of protests and demonstrations by patients' organizations, and to heavy pressures on the committee, both by the patients and lobbyists for the pharmaceutical companies, and on the government.

Dr. Yoram Blashar, chairman of the Israel Medical Association, resigned his membership on the committee at the beginning of the week, saying that its membership does not reflect the good of the public. "It was clear back in 2007 that since no new medications were added to the basket in 2007, in 2008 additional funding of at least NIS 500 million would be needed for life-saving and life-prolonging medications and those that significantly improve quality of life," Blashar told Haaretz yesterday.

The lack of sufficient funding will lead to "ongoing suffering for patients who will have to protest and go on hunger strikes and will not be able to afford the essential medications not in the basket," Blashar also said. He added that the treasury had "seen to it that the committee would be 'obedient and compliant.'"

According to the Health Ministry, Erbitux, on the "essential" list, used to treat metastasized intestinal cancer, is the most expensive. Intestinal cancer is one of the most common cancers in Israel and 1,000 patients a year may need the drug, at a cost of NIS 150,000 per patient. The document says new uses for Plavix, used to prevent blood clots, at some NIS 22 million a year, include high-risk patients after stroke and some 10,000 heart patients who have had a Plavix-coated stent implanted.

The document also defines about 30 more medications as "very high priority," including those for tens of thousands of patients with Parkinson's disease, multiple sclerosis, psoriasis, and kidney and lung disease, and 80 medications and technologies defined as "high priority," for conditions including high blood pressure and congestive heart failure. The document notes that the committee probably will not discuss these medications since the budget will not even suffice for those considered "essential."

The Health Ministry responded: "Every year the ministry fights for additional funding for the health basket. Each year the needs are greater than the budget. The constant aspiration is to increase the budget and the committee will have to prioritize the medications."