Dutch health insurers no longer fully cover 2 breast cancer meds; Patients devastated
Dutch health insurers have stopped fully covering two of three medicines for metastatic hormonal breast cancer. Since January 1, they no longer fully reimburse the drugs Ribociclib and Abemaciclib. Patients are devastated that they may have to switch off of medicine that is working for them. Oncologists are also concerned.
In 2017, the then-Minister of Public Health added three medicines for metastatic hormonal breast cancer to the basic health insurance package - Palbociclib, Ribociclib, and Abemaciclib. These medicines inhibit the division of cells, which keeps the cancer stable for longer and extends the women’s lives. The drugs differ in the severity of their side effects, which include liver problems, heart arrhythmia, diarrhea, or reduced immunity. More recent research also showed that the effectiveness of the drugs also differs, RTL Nieuws reported. About 2,000 women in the Netherlands are using one of these medicines.
The treatments are also expensive, so the health insurers started negotiating with the various pharmaceutical companies about the price last year, RTL Nieuws reported. Only Pfizer, the manufacturer of Palbociclib, was prepared to lower the price. So Zorverzekeraars Nederland only concluded a contract with Pfizer.
In theory, the other two medicines remain available to patients, but they are dependent on the agreements that their hospital made about this. In practice, the hospital will often have to pay extra to offer the medicine and many hospitals will not have the money for this.
The husband of a patient being treated with a combination of Abemaciclib and Letrozol spoke about the matter with NL Times after they found out at a recent oncologist appointment that she may no longer have access to one of the two medicines that is extending her life. A legal case to keep the medicine covered is underway, but they are not reassured, said the man, who NL Times is identifying by the anonymized name, Berardo.
"This whole situation obviously adds more stress and fear to the already challenging psychological (and physical) situation for my wife and us as family members." She was diagnosed with a form of metastatic breast cancer known as HR+/HER2-positive. "The treatment has been effective for nearly a year," he told NL Times. The use of the two medications together is considered a "standard first line of defence" in many Western European countries and the United States, Berardo continued.
“It is very worrying that breast cancer specialists were not asked whether these medicines are interchangeable,” oncologist Ester Siemerink, chair of the National Breast Cancer Consultation Netherlands (NABON), told RTL Nieuws. The health insurers claim that they are, but according to Siemerink, that is based on old scientific data and ignores additional information that has emerged from new studies in recent years.
Hospitals are already trying to figure out how to handle the situation, Siemerink said. “Some patients have already been switched. Other hospitals are still waiting. It can cost hundreds of thousands of euros per year,” she said. “We as specialists also find it very important that health insurers strive for efficient care. But doctors must always retain freedom of choice because one medicine is less suitable for one patient than for another. That is now being taken away from us in the consultation room. It now depends on individual negotiations between hospitals and health insurers.”
The Dutch Breast Cancer Association has already heard from patients worried about the change in their treatment. “It causes a lot of worry and unrest because it is a very vulnerable group that has to deal with this. We’ve heard from several women who have already been told that they have to switch to Palbociclib because of the price and not because of the effect. Because their current treatment still works.”
Zorgverzekeraars Nederland, the association for Dutch health insurers, told RTL Nieuws in writing that its decision to stop fully covering Ribociclib and Abemaciclib will save up to 15 million euros per year and thus ensure that this care remains accessible to patients in the future. The health insurers stressed that, according to them, the three medicines are interchangeable based on a study from 2024.
"Health insurers must ensure that medicines remain affordable and accessible, in the interests of the insured and the patient. If there are alternatives, we purchase as competitively as possible so that the premium can remain as low as possible and as little care as possible is displaced,” Zorgverzekeraars Nederland said.
“If the case is lost, countless women with metastatic cancer will face a significant reduction in their life expectancy, along with severe emotional and psychological consequences for both them and their families,” Berardo told NL Times. “It is deeply unjust and outrageous that lives could be cut short due to the relentless pursuit of profit by insurance companies. This situation exemplifies the harmful impact of prioritizing financial gain over human lives.”
Health Minister Fleur Agema would not comment on the content of the agreements between health insurers and pharmaceutical but did tell RTL that it was important that insurers communicate clearly and promptly about reimbursement agreements.
For now, Berardo said he and his wife are considering what to do next. "I'm evaluating the option to eventually move the whole family back to Italy, to have the most effective treatment for my wife," he wrote in an email. However, "this would be highly disruptive for our family, especially considering our children's education."
