Court rules that Insurance companies must fully cover two more breast cancer medications

Insurance companies have been ordered to continue to fully pay for the use of ribociclib and abemaciclib, two medications which are sometimes prescribed int the treatment of breast cancer. The companies have only covered a different, cheaper medication, since January 1, but this move was rejected by the District Court for Gelderland in Arnhem on Tuesday.

The case is about the use of CDK4/6 inhibitors, sometimes prescribed with other medications and therapies to treat certain receptor-positive metastatic breast cancers. The cancer is incurable, but the medicines are meant to delay tumor growth, resulting in increased life expectancy.

Health insurers think that the three medications are equal in effectiveness and, therefore, interchangeable. They opted to only fully cover the medication palbociclib, and not ribociclib or abemaciclib. This led to the latter two medications becoming too expensive for hospitals.

The court ruled that the argument that the medicines are comparable and interchangeable was not well substantiated. Women live longer with the use of the expensive drugs ribociclib and abemaciclib, the court stated.

The results when using the cheaper drug, palbociclib, are “not so clear,” the court said. This is unfair towards the insured patients, who have a right to health care, and it also disadvantages the manufacturers of the medicine, according to the court.

Health insurers have been forbidden from encouraging the provision of palbociclib. Further, they may not discourage the use of other drugs.

Roughly 2,000 women in the Netherlands are currently prescribed on one of the three medications. The three drugs keep cancer stable for a longer period of time by limiting the division of cells, but they are linked to different side effects in varying capacity. These include heart arrhythmia, the development of liver problems, reduced immunity, and diarrhea.

But only palbociclib manufacturer Pfizer was prepared to lower the cost per pill of the expensive treatments last year, prompting health insurance association Zorgverzekeraars Nederland to negotiate a new deal only with that company. That put hospitals in a position where they were forced to pay a higher portion of the costs for the other two drugs, or potentially leave patients to seek treatment elsewhere.

All three medications were added to the list of drugs covered by the basic health insurance package in 2017.