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Israel Begins Work to Determine Subsidized Medicines for 2017

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The committee deliberating on the additions to the health basket.Credit: Alon Ron

The 2017 health basket committee, which will determine the new drugs and medical technologies to be subsidized by the government next year, is due to start its work next month, with the office of Health Minister Yaakov Litzman expected to announce the panel’s members shortly.

The committee will have 460 million shekels ($121.9 million) at its disposal this year, compared to only 300 million shekels in recent years, but although the increase seems significant, it barely makes up for years of erosion of the basket’s value. The panel will have to choose from among hundreds of new drugs and technologies whose total value is between 2.5 billion and 3 billion shekels.

Health Minister Yaakov Litzman. Credit: Tali Meyer

According to information obtained by Haaretz, the chairman of this year’s committee will be Prof. Jonathan Halevy, the director of Shaare Zedek Medical Center in Jerusalem, who previously chaired the committee in 2013 and 2014. The committee, as every year, comprises representatives of the four HMOs, government representatives as well as doctors and public representatives. It must submit its recommendations to the Health Ministry by the end of the year.

The committee’s work will be coordinated by Dr. Osnat Luxenburg, director of the Health Ministry’s medical technology and infrastructure administration. The ministry will also be represented by Yair Asraf, deputy director-general for pricing and budgeting, and health economist Iris Ginsburg. Missing from this year’s committee is Revital Topper Haver-Tov, the ministry’s health funds supervisor. Topper Haver-Tov has always been very vocal in meetings of the health basket committees, often confronting HMO representatives whose economic interests don’t always dovetail with those of the public.

Health system sources say that Topper Haver-Tov’s was dropped from the committee because of the bad relations between her and Litzman, which reached their nadir in February when the two reportedly had such a fierce argument that Litzman threw her out of his office while yelling “Get out!” Topper Haver-Tov filed a complaint with the Civil Service Commission, asking that Litzman be censured for inappropriate conduct that she called “aggressive and demeaning.”

From a professional standpoint, as the person responsible for overseeing the HMOs, which must provide the public with the new remedies, her absence is will be significant.

Two of the four public representatives on the committee also sat on it last year – Prof. Ruth Landau of the Hebrew University’s School of Social Work, and attorney Yacov Kvint, the Israel Lands Administration’s legal adviser. Joining the panel this year as a public representative is Dr. Dalia Fadila, an educator who heads the Al-Qasemi Academic College for Science and Engineering in Baka al-Garbiyeh and who founded and runs the Q Schools network.

The fourth public representative this year will apparently be Rabbi Avraham Manela, director of the Tel Aviv burial society. Manela, a Gur Hasid, was a committee member in 2012, the last time Litzman headed the Health Ministry. He is considered very close to Litzman and has been mooted as a possible successor to him in the political arena. In February he was named to the new committee tasked with drawing up regulations that promote good nutrition.

The Health Ministry refused to confirm the information about the committee members, saying, “The members of the health basket committee have not yet been appointed. The issue is still being discussed.”

As every year, the health basket committee must grapple with a budget that cannot possibly meet all the system’s needs. One the one hand, every year brings new, effective, life-extending drugs and technologies – like new cancer drugs based on immunotherapy – but the costs are very high, often reaching hundreds of thousands of shekels per patient. In June the Health Ministry noted that the cost of 55 remedies that had been cited by last year’s committee as “extremely vital” and yet didn’t make it into the basket cost some 800 million shekels.

Last year the committee approved 20 new drugs at a cost of 110 million shekels. The committee last year decided not to approve Keytruda or Opdivo – both immunotherapy drugs that are in the basket to treat melanoma – as treatments also for lung cancer, which would have cost tens of millions of shekels and benefitted 400 patients. Both the drugs are expected to come up for evaluation again this year, as will many other treatments that didn’t make last year’s cut.

The committee will also have to make decisions about new treatments for Hodgkin’s lymphoma, head and neck cancer, gastrointestinal cancer and breast cancer, as well as drugs to treat heart failure and pulmonary hypertension.

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