The government on Wednesday released the new list of subsidized medicines, treatments and technologies to be added to the “health basket” for 2021, at a cost of 550 million shekels ($153.6 million).
The additions this year include 117 new medications and technologies that will be used to treat more than 170,000 Israelis. About half the budget is devoted to treating lung diseases and cancer. The committee also decided to add advanced drugs to treat Type 2 diabetes. The health basket committee, headed by Prof. Shuki Shemer, also approved treatments for heart, neurological and vascular disorders, skin diseases, genetic testing, treatments for schizophrenia, pain treatments for women with endometriosis as well as new genetic testing for cancer patients.
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Committee deliberations this year took place in the shadow of the coronavirus crisis, to which tens of millions of shekels have been devoted. The committee discussed 880 new treatments and technologies at a cost of more than 3 billion shekels. In the final phase of the discussion some 185 new treatments and medicines were included, at a cost of about 2 billion shekels.
“If the budget had been 700 million shekels, I would have been satisfied with what didn’t go in,” a committee member told Haaretz a few hours after the list was finalized. “But at this point we are cutting into the [basics] and we had to give up on essential medications in the public health basket,” he said.
The lack of funding left off essential medications for a long list of patients. The difficulty in helping a large number of patients has grown from year to year because of the increasing cost of medications, and the growth and aging of the population.
The committee decided to expand access to advanced treatment for patients with Type 2 diabetes, at a cost of 70 million shekels. Type 2 diabetes is one of the most common chronic illnesses in Israel, with almost 500,000 people afflicted with it and a similar number defined as pre-diabetes. The disease is associated with the risk of other conditions, among them heart and vascular diseases, stroke, damage to lungs and kidneys, hard to heal wounds and a higher risk of contracting more severe coronavirus.
For these patients, the criteria will be expanded for the use of drugs of the family known as SGLT2 inhibitors, which prevent the re-absorption of glucose in the blood and increase the amount of glucose in the urine. The criteria for the use of another group of drugs will also be expanded – GLP1, which mimics the influence of the hormone that controls the release of insulin from the pancreas and the balance of sugar in the blood. The expanded criteria are expected to make these drugs accessible to some 45,000 diabetes patients. However, no new drugs or treatment have been subsidized this year for patients with Type 1 (juvenile) diabetes.
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Oncology treatments occupy a large part of the health basket this year due to breakthroughs in treatments in recent years, and because they lengthen life and are more expensive. More than 80 million shekels of the subsidized health basket is earmarked for oncology treatment, including cancer of the large intestine, lung, prostrate, bladder, skin and breast cancer, and ovarian, pancreatic, lymphatic and blood cancers.
This year it was decided for the first time to include molecular testing for cancerous tumors, which are common today in the private market. These tests examine tumors to locate mutations for the best possible targeting of the tumor with drugs. The tests this year are intended only for patients with cancer of the large intestine and the bladder and cancers of unknown origin.
The committee focused its discussions this year on lung diseases, which have been a focus of the public as well in recent months due to the coronavirus crisis. The committee approved a ground-breaking drug called Trikafta for the treatment of cystic fibrosis, for which no other drug has been found effective. Trikafta received expedited approval in the United States after promising results. The drug will be used to treat 186 patients per year at a cost of 75 million shekels.
Another drug entering the basket this year is Ofev, used to treat a condition called ILD, which causes progressive scarring of lung tissue. About 1,000 patients will receive the drug, at a cost of 51 million shekels. New subsidies for asthma and lung blockages are also now available.
A one-time grant of 50 million shekels has been provided, out of which 30 million will go for the establishment of a national lung rehabilitation network to treat some 7,500 patients with lung blockages. The network may also treat recovering Covid patients, some of whom have suffered serious damage to their lungs from the virus.
Another important drug that will be subsidized this year for the first time is Orilissa, as treatment for intermediate to serious pain caused by endometriosis. The health basket committee has allocated 8 million shekels for the use of this drug by 630 women who have not been helped by other treatments.
Endometriosis is a painful condition that strikes women and girls in the age of fertility. The disease is caused when cells from the uterus migrate to other parts of the body, mainly in the pelvis. They produce blood cells that accumulate between the tissues of various organs and cause scarring of those tissues. The disease is particularly painful during ovulation and menstruation and severely compromises quality of life.
The committee decided to subsidize testing for genetic diseases in various population groups, including Ashkenazi Jews and Jews of Ethiopian and Yemenite origin as well as genetic testing in the Arab, Druze and Karaite populations. Genetic testing has also been approved prior to implantation of embryos for higher risk of cancer.
The committee devoted extensive discussion to rare diseases this year, for which drugs and treatments are particularly expensive and in some cases the medical evidence of their effectiveness is preliminary. The dilemma revolves around the potential effectiveness of the drug regarding its cost and the number of patients it could help, and debate went on until the last minute. It was finally decided to include only one medication to the list – a drug that costs 30 million shekels intended to help 539 children that suffer from Dravet’s syndrome, a rare and severe form of childhood epilepsy.
The committee excluded the drug Vimizim, used to treat the rare genetic disorder called MPS IV that causes severe damage to the heart, lungs and other systems, disability and deformities. The drug was submitted this year for the sixth time for inclusion in the health basket, at a cost of 36.7 million shekels for 25 patients a year. The committee decided not to include it because of the small number of patients it could help, arguing that the funding should be used for other drugs.
Another drug that didn’t make the cut this year is Lamzede, which slows the progress of the degenerative disease alpa-mannosidosis, and which could be used to treat four patients a year at a cost of 1.4 million shekels per patient.
The drug Translarna, used to treat Duchenne’s syndrome, a form of muscular dystrophy, was also excluded. It would be used to treat 12 children at a cost of 20 million shekels.
The expansion of mammography for women age 45-49 was also excluded from subsidies, with the committee accepting the opinion of experts that the potential for error in the results in this age group is high.
New medications costing 24 million shekels for treatment of attention-deficit disorders were also left out.