Ombudsman challenges drug aid cutoff after disease progression

Latvia’s ombudsman, Karina Palkova, has urged the government to urgently review rules for individual state reimbursement of medicines, arguing that patients can lose support when a serious illness progresses. LSM reported the appeal.

Under current rules, patients may apply for an individual assessment if their illness is not on the list of conditions eligible for reimbursement and treatment is necessary to maintain vital functions, or if no reimbursable medicines are available for a condition on the list. They may also apply if available reimbursed medicines harm their health or prove ineffective, in which case another medicine may be covered.

However, a patient can lose eligibility if a serious, progressive illness, such as cancer, worsens during treatment. The National Health Service said the process is strictly limited by Cabinet regulations.

The service said most individual reimbursement applications receive approval. In the first eight months of this year, it issued more than 1,000 positive decisions and 76 negative ones.

It also said disease progression does not mean a medicine has failed, but may mark the start of a new line of treatment. If, for example, a tumour spreads or grows while a patient is taking a medicine, doctors consider the illness to have progressed, and the patient is not eligible for individual reimbursement under the current rules, said Zinta Rugāja, a representative of the service’s Medicines and Medical Devices Department.