BPJS may backpedal on breast cancer drug policy

News Desk

The Jakarta Post


Jakarta   /  Fri, September 7, 2018  /  12:56 pm

Preventive measures: A lump growing as the first stage of breast cancer can only be detected by self-examination or through mammography.(Shutterstock/File)

The Healthcare and Social Security Agency (BPJS Kesehatan) is considering overturning its controversial decision to stop covering trastuzumab for breast cancer patients treated under its state-funded National Health Insurance-Healthy Indonesia Card scheme.

The possibility came into focus after the Health Ministry asked the BPJS to cover the costs of up to a maximum of eight rounds of trastuzumab treatment. The request was part of the ministry’s technical guidelines on the use of trastuzumab to treat certain types of breast cancer.

“We will decide whether the drug will be put back on our coverage list after the Health Ministry issues the regulation,” BPJS Kesehatan spokesman Iqbal Anas Ma’ruf told The Jakarta Post on Tuesday.

The BPJS Kesehatan removed trastuzumab, sold under the brand name Herceptin, from its coverage list on April 1, following the recommendation of the Clinical Advisory Council (DPK), which found the drug to be ineffective in treating breast cancer.

Iqbal said despite its prevailing policy, the BPJS continued to cover alternative medicine, which are also acknowledged under the national formulary, arguing that different types of breast cancer receive different treatments.

The BPJS’ decision to drop trastuzumab from its coverage list has been met with a torrent of protests, particularly after the issue came under the spotlight two months ago when 46-year-old HER2 breast cancer patient Juniarti and husband Edy Haryadi filed a lawsuit against the BPJS with the South Jakarta District Court.

Edy argued that the policy put his wife’s life in danger because other chemotherapy drugs on the market were known to be less effective in destroying HER2 cancer cells, which have a higher growth rate than other types of breast cancer.

A 67-year-old Jakartan named Poppy Noviati is living proof of the drug’s effectiveness in killing HER2 cancer cells.

Poppy said the drug helped stop the cells from replicating, which in turn has made her live healthily and breast cancer-free for almost 10 years.

“Thank God, only weeks after I started the treatment, it made me feel a lot better because it helped strengthen my immune system to fight the cancer,” she said, recalling her experience taking trastuzumab.

Oncologist Ronald Hokum said the World Health Organization (WHO) had regarded trastuzumab as an essential drug for HER2-positive breast cancer patients and listed it as the first line of defense in treating the disease.

Although the national formulary also recognizes lapatinib as an alternative drug, Ronald said it could only be administered for patients resistant to the drug.

“Lapatinib can’t be used as an alternative to trastuzumab as it can only be used in combination with chemotherapy if HER2-positive patients don’t respond to the initial treatment,” he said.

Trastuzumab is considered costly compared to lapatinib. A vial of trastuzumab could reportedly cost from Rp 20 million (US$1,345) to Rp 25 million, while a bottle of lapatinib tablets, sold under the brand name Tykerb, could only cost about Rp 4.23 million.

However, Ronald said the BPJS Kesehatan would more likely spend more money on lapatinib due to the fact that the national formulary did not limit the maximum number of lapatinib uses per patient, while it stipulated that the BPJS’ maximum coverage of trastuzumab was eight rounds per patient.

To help the BPJS Kesehatan reduce the cost of trastuzumab claims, state-owned pharmaceutical company Bio Farma is reportedly planning to sell a more affordable version of the drug, which would be released to the market by 2019. 

The company claimed that the biosimilar drug would cost 30 percent less than Herceptin, which is produced by Swiss healthcare firm Roche. (ris)