Non-cancer Drugs Shine in Israel’s List of New Meds in Subsidized 'Health Basket'

The health-basket committee has also ramped up its criticism of companies demanding high prices

Birth-control pills displayed in Sacramento, California, August 26, 2016.
Rich Pedroncelli / AP

More than 100 new drugs and technologies – at a cost of 460 million shekels ($133 million) – will be added to Israel’s “health basket” of subsidized treatments next year, though cancer products will make up around a quarter of the value, down from around half in 2017.

Also, in deliberations over the 2018 roster, members of the health-basket committee harshly criticized the drug industry for demanding particularly high prices.

The 106 new drugs and technologies in 2018 will treat more than 70,000 patients. The list includes treatments for rare diseases – at a cost topping 117 million shekels – helping 128 patients.

Despite the lower oncology percentage, the committee still approved new treatments for various types of cancer. It also approved new treatments for lung disease, diseases of the heart and blood vessels, neurological disorders and eye diseases. Israel will also be subsidizing genetic testing.

The committee will present the list to the Health Council next week, before it goes to the government for final approval.

The committee considered 700 drugs, procedures and technologies valued at 2.5 billion shekels, but for some products the price was too high.

One such drug left off the list was Exondys 51 (eteplirsen) for Duchenne muscular dystrophy. The drug costs 3.75 million shekels a year per patient. The committee said there was insufficient evidence of the product’s effectiveness.

“There is no clinical or technological reason for such an insane price,” a health ministry source told Haaretz. “This isn’t some miracle cure .... The company charges such high prices because it can. It’s the only one currently producing the drug and it won’t reduce the price by one shekel to facilitate its inclusion in the basket.”

A committee member added, referring to the inflexibility of some companies: “On the other side we encounter a bunker.” Another added: “The committee must send out a clear message that a drug for the basket, at the public’s expense, will not be approved at any cost.”

New entries

The committee did approve the drug Spinraza for spinal muscular atrophy, which can lead to death before the age of 2. After a fierce campaign by parents, Deputy Health Minister Yaakov Litzman told hospitals to provide the treatment – at a cost of a million shekels per patient. Ninety-four patients will benefit.

According to one committee member, Prime Minister Benjamin Netanyahu wanted Spinraza in the basket. Under the agreement with the company, 60 million shekels will be covered by the state.

The committee also approved a new drug for treating Fabry’s disease, a hereditary condition that leads to kidney, heart and brain damage. The drug will cost 552,000 shekels a year per patient, of which there are currently three in Israel.

Meanwhile, Orkambi will treat cystic fibrosis; the drug will benefit 45 patients, costing 644,000 shekels each, or 29 million shekels.

For the first time, the committee approved oncology drugs that treat cancer based on the tumor’s genetic characteristics, not the organ affected. One of these is Keytruda, which fights cancers including those of the lung, esophagus, pancreas, small intestine, breast, uterus, thyroid, prostate and soft tissues.

The drug costs 150,000 shekels a year per patient. The committee also approved Keytruda and Opdivo to fight cancer of the digestive tract.

The committee also added Tagrisso for lung cancer based on a certain mutation. There are six such people in Israel, and the drug will cost 156,000 shekels each. A similar drug, Alecensa, will benefit 37 patients at 202,000 shekels each.

The committee also approved the biological drugs Ibrance and Kisqali as first-line advanced treatment for metastatic breast cancer. Some 500 women will benefit from these drugs, which will cost 35 million shekels a year.

Other drugs approved include one against kidney and bladder cancers, and against neuroblastoma, a cancer originating in the nervous system that mainly affects children. The drug costs 760,000 shekels a year per patient, and will benefit 10 patients.

The committee also added a drug for women at high risk of early menopause. Israel currently funds the freezing of ova only for women whose fertility may be impaired by cancer treatments.

Other additions were tests for genetic diseases such as CGD syndrome among Jews with roots in the Caucasus, Walker-Warburg syndrome among Ashkenazi Jews, and other syndromes common among Arab and Druze Israelis.

Also approved were drugs for inflammatory bowel diseases, venous thrombosis, multiple sclerosis in cases where conventional treatments fail, and epilepsy in cases where other drugs fail. Also approved was the use of PET-CT scans for detecting a return of cervical cancer and another rare form of cancer in women.

The committee added to the basket new-generation drugs for treating type-2 diabetes; for example, for patients who have had a heart attack or bypass surgery. People with type-1 diabetes will be able to benefit from sensors that monitor blood sugar and not have to have blood drawn.

Missing the cut

The committee, however, left out funding for rehab from alcohol abuse and smoking. The committee opted not to allot 18.3 million shekels to Champix for nicotine addiction. It also decided not to add Selincro for alcohol rehab; the committee says the costs should be covered by other sources in the welfare system.

Other drugs left out include Ilaris for Mediterranean fever, an inherited condition characterized by painful inflammation of the abdomen, chest or joints. Also excluded were support belts for people with spinal problems.

The committee also did not lower the eligibility age for Pap smears to 25 from 35. Also excluded was Descovy for treating HIV, and a novel drug for brain cancer that would cost 75 million shekels.

Also left out was Aldurazyme for a rare disorder that affects tissues and limb function. Only one person suffers from this disorder in Israel; the drug costs 1.65 million shekels a year.