Israeli MoH Adds 71 News Drugs to Country's 2010 Drug Basket But Faces Massive Opposition

US$95-mil. Worth of Drugs Added to Israel's Positive Reimbursement List

The committee in charge of recommending drugs covered under Israel's public health insurance system has recommended 71 new drugs to be added to the country's "drug basket" next year. The list includes drugs for several indications, such as oncology, haematology, cardiology, neurology, infectious diseases (including HIV/AIDS), nephrology, auto-immune diseases, psychiatry, and opthalomology.

Key additions include smoking-cessation drugs—such as GlaxoSmithKline (GSK; U.K.)'s Zyban and Pfizer's Champix—and Eli Lilly (U.S.)'s non-insulin dependent diabetes drug Byetta (exenatide). The most expensive additions are Iressa, Sutent, and Afinitor, for kidney cancer, with coverage for these drugs expected to cost the government 35 million new shekels (US$9 million) annually.

Furthermore several drugs on the list are already part of the drug basket, with 2010's recommendation to see their coverage increased. For example, Teva' s Azliect will now be reimbursed for early-stage Parkinson's disease as well, in line with the drug's proven disease-modifying ability. Similarly, oncology drug Exbitux will also be reimbursed for several oncology indications, including head and neck, and metastatic colon cancer.

Other new technology additions include the addition of an artificial heart valve and new MRI scanner that will improve breast cancer detection. All of the above-mentioned inclusions are worth US$350 million and are set to benefit over 70,000 Israelis revealed Professor Rafael Beyar, the head of the 16-member health basket committee (source: Hareetz). According to Beyar, 66% of the technologies were life saving, while the others extended and improved quality of life.

The Israeli Health Ministry's list of technology included for 201 can be found here.

Free Dental Care for Children

Concurrently, the government has also approved Deputy Minister of Health Ya'acov Litzman's plan to provide free basic dental care to all children from 2010 at a cost of 65 million new shekels. The monies in question have been diverted from a previously budgeted 415-million-shekel drug budget, reports the Jerusalem Post.

Outlook and Implications

The new drug list has some significant additions and is set to increase affordability of all the drugs in the aforementioned drug basket. As indicated before, the addition of smoking cessation drugs and non-insulin dependent diabetes drug are significant and a first in the drug basket, with patients disappointed when these drugs were included in 2009's list (see Israel: 24 December 2008: Israeli Health Ministry to Add 83 New Drugs to 2009 Health Service Basket, Including Erbitux). While the addition of these drugs has pacified some stakeholders, opposition from other sections has in fact increased. Litzman's diversion of drug funds towards paediatric dental care ruffled several feathers, with some members on the health basket committee reportedly also against the move; the matter has even been taken to court. According to the Israeli Medical Association (IMA), the move has seen reduced access to key drugs such as Avastin (bevacizumab) for metastatic breast cancer, which could not make it onto the positive reimbursement list. However, beneficiaries requiring the drug may have to wait for the 2011 drug list, given that a high court ruling has favoured Litzman and the new drug list is set to be finalised shortly.

Although diverting drugs funds in itself is a controversial issue, the inclusion of dental care for children itself is no surprise. The central government's plan to increase its involvement in this matter was announced in mid 2009 (see Israel: 12 June 2009: Israeli Government to Increase Participation in Covering Dental Care for Children).