The National Health Care Institute has advised the Minister of Health, Welfare and Sport (VWS) to reimburse exagamglogene autotemcel (exa-cel; Casgevy®) from the basic health insurance package after price negotiations. This medicine can be used for certain patients with sickle cell disease. This is a hereditary form of anaemia. The reason for this advice was the placing of the medicinal product in the so-called ‘lock procedure for expensive medicinal products’.
Current state of affairs: advice sent to the Minister
The National Health Care Institute has sent this advice to the Minister of VWS. The Minister makes the final decision whether or not to reimburse the medicinal product from the basic health insurance package.
Exa-cel is intended for certain people with hereditary anaemia
Exa-cel is the active substance. The brand name is Casgevy®. The medicinal product is a single injection.
The medicine can be used in people with sickle cell disease (SCD). SCD is a hereditary form of anaemia, in which the small blood vessels can become blocked. People suffer from severe pain and the disease can damage their organs. This damage can be so bad that they sometimes need organs from a donor. Exa-cel can be used for people who are eligible for stem cell transplant, but for whom no donor is available. In a stem cell transplantation, a patient receives healthy stem cells via the blood.
Advice from the National Health Care Institute on the reimbursement of exa-cel
The National Health Care Institute advises the Minister of VWS to reimburse exa-cel (Casgevy®) from the basic health insurance package after price negotiations. The manufacturer's current asking price is too high. The asking price should be reduced by at least 24% to balance the costs with the health benefits for patients.
More information or questions?
If you have any questions about this advice, please send your question to the National Health Care Institute via warcg@zinl.nl. If you have questions about the reimbursement of a medicinal product, the personal expenses or whether you should pay a contribution, please ask your health insurance provider.
How did the advice come about?
The Scientific Advisory Board (WAR) and the Insured Package Advisory Committee (ACP) advise the National Health Care Institute when issuing package advice. The Minister makes the final decision whether or not to reimburse the medicinal product from the basic health insurance package.
Explanation of the package lock procedure for expensive medicinal products
The minister has placed exa-cel for this indication in the 'lock procedure for expensive medicinal products'. A medicinal product in this lock procedure will not be eligible for reimbursement from the basic healthcare package until:
- there is a positive package advice from the National Health Care Institute;
- there are arrangements and safeguards for appropriateness in place;
- price reductions have been successfully negotiated with the marketing authorisation holder.
For more information, see the page ‘Lock procedure for expensive medicinal products’.