Health minister keeps breast cancer treatments out of basic insurance over high prices

Three new treatments for a specific type of breast cancer will remain excluded from basic health insurance coverage for now. Acting Health Minister Jan Anthonie Bruijn explained to the Tweede Kamer, the lower house of Dutch parliament, that the drugs are being kept in the so-called “sluice” because the ministry considers them too expensive. Negotiations with the suppliers over what he called “a socially acceptable price” were intensive but unsuccessful.

The medications involved are Xenpozyme, Carvykti, and Enhertu, all aimed at treating HER2-low breast cancer, a particular subtype of the disease. Enhertu, however, remains covered for patients with HER2-positive breast cancer.

According to the minister, the requested prices are far above the recommendations of the National Health Care Institute, which recognizes the drugs’ added value but concludes that the health gains do not outweigh their high cost.

The ministry stressed that the healthcare budget operates on the principle of solidarity, warning that prices disproportionate to the health benefits are unacceptable because they could jeopardize other forms of effective and efficient care.

The National Health Care Institute estimates the proposed price of Enhertu for treating HER2-low breast cancer at roughly 95,000 euros per patient based on the current market price.

The medications are part of the Netherlands’ “sluice for expensive medicines” system. Under this mechanism, new and costly drugs are temporarily kept out of the basic health insurance package until price negotiations are successfully completed and four key criteria, effectiveness, cost-effectiveness, necessity, and feasibility, are met.

Bruijn acknowledged that “it is difficult to make this decision” and called it “deeply disappointing” for patients and their families. However, he emphasized that drug prices must reflect their health benefits, noting that anything else would be an irresponsible use of public healthcare funds. “The high prices demanded by suppliers undermine the solidarity of our healthcare system,” he wrote in a letter to parliament.

The minister described Xenpozyme’s price as “exceptionally high,” estimating it at about 900,000 euros per patient annually. The National Health Care Institute says the price would need to fall by at least 92 percent to be acceptable. The other drugs would also have to drop by several dozen percent. Bruijn urged the manufacturers to reconsider their prices.