Medicine Trodelvy not in basic package | News item

News item | 28-03-2023 | 1:00 pm

Minister Ernst Kuipers (Public Health, Welfare and Sport) will introduce the medicine Trodelvy do not include triple-negative breast cancer in the basic package of insured care. According to the advice of the Zorginstituut, the price that the supplier asks for the product is not in proportion to the health benefits it produces; a discount of 75% is required for this. The supplier has proved unwilling to offer this discount.

Minister Ernst Kuipers: “Of course I would have liked to see the supplier agree to a socially acceptable price, so that the product could have been included in the basic package. Unfortunately that did not happen. The dilemma is that this medicine does produce health gains, but that health gain is not in proportion to the price that is asked for it, so that there is no question of effective care. Inefficient spending on a drug means less money is available for other important areas of care. That is not the direction I want to go.”

Because the negotiations between the ministry and the supplier of Trodelvy (substance name: sacituzumab govitecan) have not been successful, the medicine will not be included in the basic package. The negotiations have shown that the supplier is not prepared to comply with the advice of the Zorginstituut. If the supplier is still prepared to reach an acceptable price agreement, then Minister Kuipers is prepared to reconsider his decision.

Solidarity under pressure

Expenditure on healthcare is rising rapidly. To ensure solidarity in our reimbursement system now and in the future, it is necessary to curb drug prices and expenditure. It can therefore happen that a medicine does provide health benefits, but that those health benefits are not in proportion to the price that is asked for it, so that there is no question of effective care. With the conclusion of the integral care agreement, it has become all the more clear that sometimes sharp considerations have to be made about what our collective financial resources are used for.

Trodelvy is a medicine for a certain type of breast cancer, triple-negative breast cancer. This medicine can be used after patients have had at least two previous lines of drug treatment and these have stopped working. Patients treated at this stage do not get better. Patients live an average of 5.4 months longer after treatment with Trodelvy.
In the Netherlands, it is expected that 139 patients will be treated with Trodelvy per year. The drug costs an average of € 68,707 per patient. This would increase the expenditure on Trodelvy to € 9.6 million per year.

Drug lock

Trodelvy was placed in the so-called lock for expensive medicines at the end of 2021. The National Health Care Institute then assessed Trodelvy for use in triple-negative breast cancer and advised the minister to only include Trodelvy in the basic package if a minimum discount of 75% on the price was agreed with the supplier of Trodelvy. The 75 percent discount is necessary to arrive at a cost-effective price. With a lower discount percentage, Trodelvy’s reimbursement implicitly leads to the displacement of care that is more cost-effective.