Health insurers no longer completely cover two breast cancer drugs for women with metastasised hormone receptive breast cancer because of high costs.

Three types of drugs – palbociclib, ribociclib and abemaciclib – had been covered by the basic health insurance since 2017 but in the case of the two latter drugs, that is no longer the case.

“This came as a bolt from the blue for both patients and oncologists,” Ester Siemerink, an oncologist and chair of the breast cancer consultation group NABON, told RTL Nieuws.

The drugs are expensive, and during negotiations with the pharmaceutical companies, only Pfizer, which makes palbociclib, was willing to go down in price. The other drugs will now only be available if hospitals are prepared to pay extra for them, which, experts say, is doubtful.

“It is very worrying that oncologists were not asked about whether or not these drugs are interchangeable,” Siemerink said. Insurers are basing their decision on outdated scientific findings when much more is now known about the different effectiveness and side effects of the three drugs, she said.

Novartis, the makers of ribociclib, is currently suing the Dutch insurers because, it says, the drugs are not comparable.

The drugs in question are so-called CDK4/6 inhibitors which slow down the division of cancer cells, stabilising the disease and so prolonging life.

Some 2,000 women in the Netherlands are treated with a CDK4/6 inhibitor, depending on their tolerance for the drug which have different and often serious side effects, including diarrhea, heart rhythm problems and a compromised immune system.

Patient organisation Borstkanker Nederland said it had been contacted by worried patients who are being faced with being given a different drug. “This is a very vulnerable group of people. We have been told by several women they have been put on palbociclib, not because their normal medication did not work but because of costs,” a spokesperson for the organisation said.

Insurers

The organisation for insurers Zorgverzekeraars Nederland said in a written reaction the drugs are interchangeable and that the move will save €15 million.

Health minister Fleur Agema said it was important to communicate changes to the basic health package in time but did not comment further.

PVV MP René Claassen slated the insurers’ decision saying, “Profit seems to trump treatment policy and the insights of oncologists”.

D66 MP Wieke Paulusma questioned the attitude of the pharmaceutical companies. “If one could lower the price, why couldn’t the other two?”, she said. The minister, hospital, insurers and pharmaceuticals should go back to the negotiating table,” VVD MP Judith Thielen said.