The National Health Care Institute has advised the Minister of Health, Welfare and Sport (VWS) to reimburse ipilimumab in combination with nivolumab from the basic health insurance package after price negotiations. These medicinal products can be used in certain patients with colorectal cancer. The reason for this advice was the placing of ipilimumab 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.
Ipilimumab in combination with nivolumab is intended for certain people with colorectal cancer
Ipilimumab and nivolumab are the active substances. The brand name of ipilimumab is Yervoy®. The brand name of nivolumab is Opdivo®. Both medicinal products are injections.
People with a subtype of colorectal cancer can use these medicinal products. In this subtype, the proteins that clean up mutations in the DNA can no longer do that properly. It concerns first-line treatment of inoperable or metastatic mismatch repair deficient (dMMR) or microsatellite instability-high (MSI-H) colorectal carcinoma (CRC). Colorectal carcinoma is a medical term for colorectal cancer. First-line treatment means that the patient has not had previous treatment. Inoperable means that the tumour cannot be removed surgically. Metastatic means that a tumour has grown in various places in the body.
Advice from the National Health Care Institute on the reimbursement of ipilimumab
The National Health Care Institute advises the Minister of VWS to reimburse ipilimumab (Yervoy®) in combination with nivolumab (Opdivo®) from the basic health insurance package after price negotiations. The treatment must be cost-effective. Cost-effective means that there is a good balance between the price of the medicinal product and the health benefits it creates. Due to confidential price negotiations for nivolumab and pembrolizumab , the National Health Care Institute cannot calculate a precise price discount.
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) advises 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 ipilimumab 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’.