The basket committee submitted 900 drugs and treatments for over NIS 3.5 billion this year, 7 times the budget • The most expensive drug is to treat leukemia at a cost of NIS 34 million, about 7 percent of the drug basket budget • Direct broadcast: The drug basket committee submits its decision to the minister Litzman Health

News for patients: The Public Committee for the Expansion of the Pharmaceutical Basket this year approved the addition of 141 drugs and drug technologies for over 210,000 patients, with a total cost of NIS 500 million (of which NIS 39 million was pledged to fund treatments introduced in previous years. Cancer, but also genetic testing and treatments from preventive medicine such as vaccines and early detection of disease, innovative gene therapy that prevents blindness, treatments for HIV and diabetic patients, corsets that allow movement for children and adults with scoliosis or spinal cord injury and asthma treatment. No extra cost, because That they are given at the site or alongside other treatment.

Photo: Ami Shamir

This year, the basket committee submitted 900 drugs and treatments with a cost of over NIS 3.5 billion, 7 times the budget. Therefore, tough negotiations were held with the pharmaceutical companies, which was also personally led by the committee chairman, Prof. Ze'ev Rothstein, with the aim of leading to a decrease in drug prices.

The basket committee's work was delayed by about a month this year and lasted longer than previous years. Also due to the fact that until about a month and a half ago, there was no approved budget for the committee, but also because of a different work practice. The most expensive drug that has entered the drug basket is Lockesturna, a one-time gene therapy that prevents deterioration of vision to the point of blindness, and is aimed at those with a specific mutation of the retinitis pigmentosis eye disease. The cost of treatment is close to NIS 3 million per person per year. The treatment involves injecting a healthy copy of the damaged gene onto the retina virus, which helps restore the retinal cells.

It is a very rare disease and the treatment is put in the basket for one person a year. However, there is an immediate need to treat 11 patients who currently have a one-time cost of NIS 27 million. This is made possible by the fact that the basket committee's decision was given late this year and will only take effect in early February.

In light of this, a one-off surplus of about NIS 40 million was created (the relative part of January), which allowed the committee members a number of creative solutions alongside the anti-blindness treatment.

Thanks to the budget surplus, this year an experimental program, in collaboration with the HMOs, will be started for early detection of lung cancer patients. Under it, heavy smokers, 55 years of age or older, who previously had 30 years of smoking a box a day, or 15 years of two boxes a day, would undergo a low intensity CT examination. The test has proven to reduce lung cancer mortality, which is the deadliest in Israel, by 26 to 40 percent.

A budget surplus of about NIS 6 million will be used on a one-off basis to treat dental bruising caused to students during school. The Ministry of Education decided this year, abruptly and without coordination, to exclude the treatment from the students' insurance and the issue came to develop the Health Basket Committee. The amount will be used for insurance for one year at the Inbal government insurance company, while a professional committee will be set up to examine the issue of dental floss insurance for students and submit its conclusions to the drug basket next year to find a permanent solution.

As every year, cancer drugs and blood cancers get the largest proportion

The drug that comes in at the highest cost is IMMROVICA, for the treatment of chronic lymphocytic leukemia. The cost of first treatment for 280 patients and 25 patients with rare lymphoma amounts to a total cost of NIS 34 million, about 7 percent of the budget of the drug basket. It is a breakthrough treatment that prevents B cell culture and migration that helps to neutralize the cancerous cells.

Other drugs that have been used to treat cancer are lineage for 140 ovarian or fallopian cancers, which carry the BRCA genetic mutation. As well as metastatic breast cancer treatment for 43 mutant carcinoma breast cancer patients. The drug Cadzilla, which responds to 137 early HER2-positive breast cancer patients, the drug Tesentric, responds to 49 Triple Negative breast cancer patients. The immunotherapy treatment for Libatio, the first treatment for dandruff skin cancer, the immunotherapy therapy for the treatment of metastatic cervical head cancer patients as a first line therapy, as well as for the treatment of advanced stage melanoma.

At the same time, the advanced and metastatic kidney cancer treatment framework has been expanded to include ten drugs, including epinitor, opedibo and herbicide. Entered a one-time treatment called Belverse, the first treatment for 20 patients with bladder cancer. Genetic testing has also been undertaken to examine the molecular profile of NSCLC lung cancer patients enabling customized medical care.

After a three-year battle, a basket of helmet and magnetic fields called Option came into the basket for patients with glioblastoma brain cancer. 20% of patients who used the helmet lived for four years.

Special medicines

Kathmandu (Spravato) spray for treatment of depression, durable after the patient has not responded to treatment with two previous medications. This is a treatment that affects within 24 hours of treatment and about 70 percent of patients respond to it. After years when no new and effective mental health drugs came in. One of the committee members noted that "this is one of the most common disorders in the world. Causes morbidity and mortality due to loss. Mental health is an area that has been answered by the basket committee very few times. It is an impressive treatment for such an important issue."

Another expensive treatment that comes in is eye drops called "cyst droppings" at a cost of about NIS 200,000 per patient for a corneal-destroying disease. This year, the committee was able to reach a creative and special agreement to enable stem cell therapy to cure fistulas in Crohn's gut patients.

The introduction of the expensive treatment, which cost NIS 278,000 per patient, and is intended for 48 patients, was made possible after the company pledged to fund the treatments that were unsuccessful. According to the studies, the success rate of treating these severely ill patients is 50 percent.

The basket committee entered the basket this year, costing about NIS 7,000 for a thousand patients. It is a treatment for congenital scoliosis and scoliosis after trauma or illness. Among the patients, children who do not have early treatment with a corset cannot start walking.

preventive medicine

The Medicines Committee has been able to introduce many preventative medicine treatments this year, including completing the measles and mumps vaccine, which has received the highest importance. The 8th grade cervical cancer vaccine has been upgraded to protect against 9 strains of papillomavirus, rather than four strains like today.

This year, a BRCA gene mutation test was introduced that increases breast, ovarian and pancreatic cancer risk for Ashkenazi women aged 30 to 65. One out of 40 Ashkenazi women may carry the mutation and carriers detection and can track women for periodic cancer screening and preventive measures .

Eligibility for PAP for early detection of cervical cancer for women aged 25 to 30 has also been expanded, as has been carried out for screening for carcinoma of the hard muscle, Duchenne for the general population and for screening for serious illnesses in the Druze, Muslim and Bedouin populations.

The committee succeeded in completing a budget hearing aid budget for the entire population, when this year they introduced the latest group of patients - aged 52 to 64, who will receive a refund of NIS 3000 on the purchase of a hearing aid.

Additional treatments

Another drug that goes into the basket is the drug Dupixent, for the treatment of severe asthma for patients treated with steroids and for patients who did not respond to another treatment. In addition, medical food was also provided for cancer patients and patients with food absorption disorders and a variety of other diseases. New cholesterol-lowering injections that came in previous years will also be given this year to more patients whose statin therapy has been of no use and is at high risk.

The "most expensive drug" Zuljansma gene therapy for the deadly SMA muscular dystrophy to treat infants up to the age of two has been able to enter the drug basket "at no extra cost". The drug, which cost NIS 7 million, is given as a one-time treatment, and the pharmaceutical company agreed to deploy payments that would be the same as a parallel drug called Spinnerza, at a cost of NIS 1 million per patient. The company also agreed to fund infants who would not respond to the treatment, at its expense, of the equivalent drug as an alternative.

In addition, advanced treatments for the SGLT2 family of diabetes, including Forsiga and Jardians, have been added to 35,000 patients with a broader outline. These are treatments that also help protect the heart and kidneys of diabetics. Another system called "Flash", which is used to monitor children's sugar levels, as well as funding for an adult diabetes monitoring system with type 1 diabetes, who underwent 3 events of extreme imbalance over three months.

The drug "Lianant", for patients with the difficult and incurable CTX syndrome, entered the basket this year, following a long battle with the "pig price" of the pharmaceutical company. This is a treatment that previously existed in another name but the company registered a patent and jumped the price of the drug. The state approved a parallel import of an alternative and cheap drug, but the company petitioned the court.

The remedies left out of the basket

The drug Abraxen is the only treatment for metastatic pancreatic cancer, but members of the committee were impressed that it only adds three months of survival to poor quality of life patients, with severe side effects when about one-third of patients develop toxicity to the drug and decide not to put it. Neither did the tetracentric drug for metastatic lung cancer go into the basket, or the drug would be used for metastatic or non-autonomic melanoma, because the committee was having difficulty impressing on the scientific evidence that only a few patients had a life extension.

Particularly expensive out-of-the-box treatment is the drug and implant for patients with the Morquio Syndrome Metabolic Disease, at a cost of NIS 1.6 million for 19 patients. After a lengthy debate, members of the Basket Committee waived the introduction of the drug in Tamiga to treat irritable bladder. Irregular bladder treatment prevents the night of the elderly and prevents falls, fractures and even death.

Other treatments that have not come in are cochlear implant funding for one-ear plaque, bi-spring therapy for women with menopausal symptoms, genetic diagnosis before reimbursement for birth control babies with BRCA gene mutation, bovidol treatment - the first treatment for opiate drug withdrawal, cyprolysis for the treatment of , The drug Kabbilby, a life-saving drug for rare blood disease and autoimmune TTP.

In the final hour of discussions, the committee decided not to fund a trip to preserve fertility for women with low ovarian reserve this year, after similar treatment for women with various genetic syndromes came in last year.

An uproarious debate has been held around funding for "artificial pancreas," an automated hybrid system that not only monitors sugar levels but also allows insulin to pass up when sugar levels are high. The chairman of the committee, Prof. Rothstein, negotiated a successful price drop and cost about NIS 10 million for 11,000 patients, but encountered fierce opposition from one of the HMOs who said the agreement could jeopardize the health fund. , At its peak, the committee member threatened to abandon the hearing, accusing the chairman of the commission of endangering the fund's budget, while the chairman blamed the fund's representative only for the budget and not caring for patients. Attempts to reach an agreement on this issue lasted a little to two at night but without success.

The basket committee is a public committee, of which 20 are members, including public representatives, doctors' representatives, representatives of the health funds and the Ministry of Health and the Treasury. The decisions are made after reviewing the research and weighting of recommendations from physician associations, and for the first time also patient reviews. Decisions are made by consensus. One member of the committee noted that "each of us needs to be comfortable with himself and his decisions, otherwise we will not be able to live with ourselves when a patient whose illness cure is left out. And those patients we see all year round. We have to ourselves, to be confident in a million percent decisions and that is essential The consensus here. "