Health insurers worried about court order to cover expensive cancer meds

Health insurance companies are “very concerned” about their ability to force lower prices being restricted after a court ruled that they had to fully cover two more expensive medications. The court in Gelderland ruled on Tuesday that the insurers have to stop their policy of only fully compensating the cheaper medication for breast cancer while not covering two more expensive medications.

Zorgverzekeraars Nederland (ZN), the umbrella organization of health insurers in the Netherlands, thinks that the court “undermines” the sector’s “crucial purchasing role, ensuring that medicines remain accessible and affordable for everyone."

The case was regarding so-called CDK 4/6 inhibitors. These agents extend the life of women with metastatic breast cancer who can no longer be cured. Three manufacturers provide the inhibitors.

The health insurance companies think that the medicines are of a similar level in quality, and therefore, the price should be the deciding factor. The medicine made by Pfizer was the cheapest of the three. A different medicine manufacturer, Novartis, did not agree with this and filed an objection.

The court ruled in Novartis’ favor on Tuesday. The court concluded that based on the most recent scientific research "it cannot be maintained that the three CDK4/6 inhibitors are equal in quality and therefore interchangeable.”

Zorginstituut Nederland, who advises the government about which medications need to be compensated, saw an “equal therapeutic value” between 2017 and 2019.

However, doubts were cast regarding this in a study published later: more evidence of efficiency was seen amongst the two more expensive medicines than the medication that the insurance companies preferred. However, Novartis and the insurance companies do not agree on the results of this study.

The insurance companies, who worked together on this, did not make the decision regarding the preferred medication carefully, according to the court. An "objective and fair price comparison" was lacking, in the court's opinion.