Starting April 1, the Health Insurance Fund will expand its list of covered medicines to include several essential treatments for rare conditions. These include medicines for aggressive skin lymphoma, inoperable benign tumors, and chemotherapy for advanced bladder cancer, offering new hope to patients with limited treatment options. The Health Fund remains committed to ensuring access to the best medicines and treatment methods. The estimated budget impact of these additions, covering both discounted and hospital drugs, is nearly four million euros.
From the beginning of April, the Health Insurance Fund will start financing a new orphan drug called Koselugo (selumetinib), which is the first drug to receive marketing authorization for the treatment of neurofibromatosis. Plexiform neurofibromas are benign tumors of the peripheral nerve sheath that can occur in any area of the body. These benign tumors grow quickly and become very large, and they are difficult to remove surgically. Getter Hark , Service Manager for Reimbursement and Prescription Management of the Health Insurance Fund explained:
“People’s complaints depend on the area and extent of the tumor and can be very different: pain, deformation of body parts, motor dysfunction, visual, bladder and/or bowel function disorders. In more severe cases, the unstoppable growth of the tumor can also cause disability or prove life-threatening due to airway obstruction…These are rare skin lymphomas that, in advanced stages, severely affect the quality of life of patients and can be fatal. The syndrome can be accompanied by the removal of the superficial layer of the skin and disturbances in temperature regulation, which is why patients are constantly feeling cold…”
There are currently two patients in Estonia who need the drug. Depending on the person’s weight, the price of annual treatment can reach up to 100,000 euros. One important innovation in the list of drugs is the active ingredient mogamulizumab, which is used to treat advanced mycosis fungoides or Sézary syndrome. For patients, who are expected to live up to ten years in the coming years, the treatment option is promising.
The active ingredient avelumab is also added to the list of medicines financed by the Health Insurance Fund. This is the first immunotherapy to be financed for bladder cancer after chemotherapy. An estimated 15–20 patients need the medicine per year. According to Dr. Helis Pokker, Head of the Oncology and Hematology Clinic at the North Estonia Regional Hospital:
“The Health Insurance Fund has been compensating for immunotherapy in the treatment of various tumor sites for several years. Now, for the first time, immunotherapy options are expanding to patients with urothelial cancer whose disease is either advanced or locally spread and whose disease has not progressed after chemotherapy… The addition of immunotherapy and a new agent as maintenance therapy after chemotherapy significantly prolongs the survival of patients with urothelial cancer, bringing the median survival to 21.4 months. In some patients, the effect of immunotherapy can last for several years, and patients live either completely disease-free or with well-controlled disease”
Although international treatment guidelines recommend platinum-based chemotherapy as the first-line treatment for metastatic cancer, despite an initial good response, the disease progresses in many patients within an average of nine months, and the median survival is generally around 14–15 months, according to Pokker.
Among other things, an amendment will also come into force, introducing a new treatment combination (active ingredients venetoclax and ibrutinib) as the first-line treatment for patients with lymphocytic leukemia. “The estimated cost of the drug for the Health Insurance Fund is three million euros per year. There are an estimated 60 patients in Estonia who need treatment, and thanks to the new treatment combination, it is possible to significantly delay the progression of the disease,” explained Getter Hark.
The Health Insurance Fund continues its efforts to ensure that patients have access to the best possible medicines and treatments. The estimated budgetary impact of all medicines added from April (both subsidised and hospital medicines) is approximately four million euros.
