The Israeli Health Ministry is spearheading a move aimed at setting a maximal price for medicinal cannabis for children and adults with autism, who are treated with this drug on a regular basis. The target is 500 shekels ($142) a month.
This comes on the heels of an earlier announcement by the ministry, relating to people requiring 30 to 50 grams cannabis a month. They will pay up to 500 shekels a month as well. The same limit will apply to children and adults with cancer, regardless of the amounts they require.
In a letter sent recently by the ministry’s director-general Moshe Bar Siman-Tov to ALUT (Israeli Society for Children and Adults with Autism), following a meeting he held with the organization’s representatives, he announced that the Health Ministry had submitted a request to the inter-ministerial committee charged with price supervision, asking for cannabis products to be part of the list it monitors.
ALUT has recently been approached by worried parents of children and young people with autism, due to the impending implementation of the reform in the use of medicinal cannabis, which is expected to lead to a dramatic rise in prices. According to the previous arrangement, users of medicinal cannabis in Israel paid a fixed monthly price, regardless of dosage or the type of cannabis required.
This is expected to change as the reform kicks in. The reform redefines the medicinal cannabis market, basing it on free competition between producers. However, it is already apparent that new price levels will harm people requiring more than 30 to 40 grams a month.
The use of medicinal cannabis by children is currently restricted to children with autism or severe epilepsy in which conventional treatment does not improve their condition. In many instances there is an overlap between these two groups. With severely autistic children, cannabis use is well recognized. It is taken as oil extracted from the plant and is often associated with a reduction in violent behavior, a calming effect, an increased appetite and improved communication.
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According to people in the business, cannabis oils are used on a daily basis, and the average usage by a child with autism is six vials a month. Children with epilepsy typically require four vials a month. These oils contain the active ingredient CBD, and prices range from 130 to 150 shekels per vial for low concentrations, rising to 200-250 shekels for highly concentrated oils.
Currently, parents of these children pay a fixed price of 370 shekels a month. When the reform kicks in, this will rise to 600 and possibly 1,500 shekels a month, or even higher in some cases.
The Health Ministry is allowing users with autism to continue receiving cannabis according to the old arrangement, excluding them from the new rules until July 2020. This arrangement was brought about by Avigail Dar, mother of a young person with autism and a member of the ALUT directorate. She worked with the AHAVA non-profit organization for the disabled to obtain a one-year exclusion from the new reform.
“Using cannabis for autism and epilepsy has a strong scientific basis, relating to CBD oils at high concentrations. The cannabis species used are harder to grow, making it more expensive to produce the oil. Only two companies in Israel provide these, Tikun Olam and Better. My son consumes 60 grams a month, in six vials costing 250 shekels each. This is an unreasonable price, especially when taking into account that this is a last-ditch effort for someone who’s tried all other medications,” says Dar. ALUT’s CEO Yoav Hefer wrote to the Health Ministry that “this is a significant burden, which in some cases may lead to a cessation of treatment, even when it’s effective and required.”
Who will finance the subsidy?
The ministry decided to try and promote a few amendments which would assuage concerned users. It’s announcements, each time directed at different groups, reflect an awareness of these concerns about rising costs.
There is a big question mark looming over the issue, with doubts as to whether the inter-ministerial committee will approve the ministry’s request. The medicinal cannabis reform is based on a free market scenario, with the assumption being that competition between providers will benefit consumers, leading to a fairer link between quantities and types of products and their prices.
Market prices at this stage reveal a wide swath of consumers for whom the reform is a harsh decree, raising prices far beyond the fixed 370 shekels a month they currently pay. It turns out that the more seriously afflicted consumers, whose earning potential is more limited and who are the ones requiring heavier doses, will have to pay huge sums for their cannabis.
The public health system should take action, but its intervention in the market could lead to a chain reaction which will harm the cannabis market, and thus consumers as well. The question is who will finance the subsidy sought by the ministry? Will it be the providers, and will this affect the quality of the extracted oils? Another option is to include this subsidy in the basket of approved drugs for these groups, as is done for other treatments. However, each option comes with a cost. The question is, who will pay for it?