Norway backs downs over plan to exclude anticancer drugs from coverage

BMJ 2013; 346 doi: (Published 14 March 2013) Cite this as: BMJ 2013;346:f1707
  1. Anders Hansen
  1. 1Stockholm

After strong public reaction, Norway’s health minister, Jonas Gahr Støre, has reversed a decision to exclude the two anticancer drugs ipilimumab and abiraterone from the list of drugs covered by national insurance.

Ipilimumab is a human monoclonal antibody used against inoperable melanoma or in cases where the melanoma has spread. The drug has been shown to prolong the life of most patients by two to six months. The government has calculated that it costs about 880 000 krone (£100 000; €120 000; $150 000) to treat each patient. Abiraterone, which is used against cancer of the prostate that has spread to other organs, has been shown to prolong life by around four months. The cost per patient is 270 000 krone.

Because of the drugs’ high costs and limited effects they were recently withdrawn from coverage by the national insurance scheme. Bjørn Guldvog, chief medical officer and head of Norway’s Directorate of Health, commented on the decision on the home page of the directorate’s website: “We have made the difficult decision not to implement the use of these medications in Norway. The conclusion is made on the basis of the following rationale: the effect of these medications is very limited, and they are very costly.”

The withdrawal of the drugs provoked widespread debate. In an unexpected turn of events the health minister announced on 13 March that the decision to exclude them had been withdrawn. All patients in need of ipilimumab will get it. With regard to abiraterone the situation is not yet clear.

The change in policy seems to have been decided despite negotiations with the manufacturer of ipilimumab, Bristol-Myers Squibb, over its price.

Guldvog said on the directorate’s home page: “I can reveal that we were offered a ‘secret deal’ that would have provided us with the medication at a lower cost. Several other countries have accepted this offer and are now able to purchase the medication at a manageable cost. However, we consider such arrangements unethical.”


Cite this as: BMJ 2013;346:f1707