Health Ministry Mulls Reinstating Coverage for Life-saving Drugs

Israel's Health Ministry considering reinstating some treatments to HMOs’ supplemental insurance plans

Dreamstime

Seven years after the removal of several life-saving drugs from the list of drugs provided by health maintenance organizations’ supplemental health insurance plans, the Ministry of Health is considering reversing that decision. This will enable tens of thousands of patients to receive these medications at reduced cost.

The Health Council met on Thursday to ratify recommendations made by a committee that decides each year which drugs are included in a nationally sanctioned list. Such drugs are provided by HMOs free of charge, regardless of whether a patient has supplemental insurance. The ministry’s director general said it was time to re-examine earlier decisions made in 2008 that excluded life-saving or life-extending drugs from supplemental plans. He added that solutions would be sought for people who could not afford such plans.

Until 2007 the HMOs provided such drugs in their supplemental plans, but these were dropped in 2008. The Health Ministry and the treasury agreed that life-extending drugs would become part of the nationally funded drugs provided by HMOs. This was meant to enable people without supplemental insurance to benefit from such medications.

Former Health Minister Yael German emphasized last year the need for the state to fund such life-extending measures for all those requiring them, even if they don’t have additional insurance.

In practice, however, it turned out that tens of thousands of people with serious illnesses such as cancer did not obtain these drugs.

The allocated annual budget of 300 million shekels (just over $75 million) was insufficient to include the required drugs in the approved list. The committee that decides which drugs are included has been adding more cancer-treating drugs to the list in recent years. However, as more focused and expensive anti-cancer drugs are being developed, the gap between their costs and the allocated budget cannot be bridged.

The list of drugs included in the state-sanctioned list is generous and diversified, compared to other countries. The expensive drugs that were included until 2008 were an important component of the list. Some of these cost tens of thousands of shekels a month and many patients had to buy these drugs on their own, privately or through private health plans purchased beforehand. Seventy-five percent of Israelis have supplemental insurance, while 20 percent cannot benefit from drugs that are not on the approved list.

Many female victims of cancer suffer from the fact that medications they require are not on the approved list. Several of them, represented by cancer patient Michal Melamed-Cohen, appealed to German when she was health minister, complaining that they could not obtain the drugs they needed. In response to the latest Health Ministry decision, Melamed-Cohen said that “we are happy with the declared intent of returning these drugs to the list. Thousands of patients who were prevented from obtaining them suffered from the lack of access to such drugs. It’s hard to describe a situation in which someone cannot afford to buy a medication that could save or extend his or her life. No words can describe the distress of their families. However, the final approved list still excludes such drugs.”

Changing the approved list requires the assent of the Ministry of Finance. Changing things during a transitional government is unlikely.

Eli Depes, CEO of Clalit, Israel’s largest health maintenance organization, said that he welcomes any change in the Health Ministry’s attitude. “Over the last few years Clalit has repeatedly suggested to the Health Ministry that drugs that are not in the nationally-approved list be added to those included in the HMO’s supplemental insurance, as well as suggesting plans to aid those who cannot afford them. Unfortunately, we encountered resistance from people unfamiliar with the situation on the ground.”