The majority does not support the FRP proposal to end the Decision Forum – Specialist Health Service, Medicines, Politics and Economics
In early April, the Progress Party put forward a representative proposal for a new amendment to the Decision Forum. Party leader Sylvi Listhaug, together with the representatives Hans Andreas Limi, Morten Wold and Bård Hoksrud spoke out to look to Denmark.
To VG said Hoksrud, who is the party’s health policy spokesperson:
– Enough is enough. Money reigns, patients suffer. We must end that.
In Norway, decisions are made on whether new drugs and other methods should be introduced in the specialist health service in the Decision Forum. The proposal states, among other things, that «it is unfortunate that the Decision Forum has only the four managing directors of the health trusts and one observer from the user committees».
The FRPs point out that the Danish models for approval include a council that makes decisions on recommendations. This council consists of 16 members and four observers.
Well, the recommendation from the health and care committee is ready.
The majority of committees – the Labor Party, the Center Party, the Socialist People’s Party and the Red Party – do not support the proposal.
FRP’s proposal for changes to New Methods
- The Storting asks the government to reorganize the Decision Forum for new methods according to the same model as used in Denmark.
- The Storting asks the government to remove the requirement that all new medicines must be methodically evaluated.
- The Storting asks the government to ensure that the health authorities’ willingness to pay for a quality-adjusted life year is increased to be at the same level as in comparative countries in Europe.
- The Storting asks the government to ensure full public access to the justification of the Decision Forum for new methods, at the same time as the unit prices of medicines can be kept confidential. (Right with)
- The Storting has set up an appeal body for decisions from the Decision Forum for new methods, which assesses the rejection cases.
- The Storting asks the government to follow Proba’s recommendation to review the exemption scheme so that it is in line with the intention in Meld. St. 34 (2015–2016) and ensures an exemption until medicines have been introduced in the health service. (Right with)
- The Storting asks the Government to establish a system for quality assurance of the method evaluations of the Norwegian Medicines Agency in order to ensure legitimacy of the decisions made in the Decision Forum for new methods. (Right with).
The Danes look to Norway
The majority of the committee refers to the evaluation of the System for new methods that Proba social analysis handed over to the Minister of Health last year. Proba assessed the organization of the Norwegian models against other countries, including Denmark.
«Against this background, the evaluation did not recommend a fundamental restructuring of New Methods. The majority believes that it is a strength in the Norwegian models, ensures equal access to methods throughout the country. The majority will also recognize that the decision-making responsibility is separate from the investigator’s responsibility in the Norwegian models », it says in the setting.
«It is also important to note that the Danish Medicines Council only evaluates medicines, while the Norwegian system has a broader mandate to evaluate all methods. The majority also notes that in 2021 Denmark introduced a new practice of method evaluation according to the same model as Norway. “
In addition to the proposal to change the Norwegian system after inspiration from Denmark, the representative proposal also contains a number of other proposals with the aim of gaining rapid access to new drugs (see fact box).
– Pinglete
The representative proposal contains a number of different proposals with goals for rapid approaches to new doctors.
Proposer Bård Hoksrud is very frustrated by the lack of support for the proposal as a whole.
– The other parties are naughty. They fail at anything that would mean anything to patients quickly. They will wait, investigate and see, says the FRP.
He lets himself be fired up by what he thinks are “stupid proposals” from the other parties.
– I am a little provoked by the Conservatives, who say that they are preoccupied with this. But they are just busy investigating. We must take action now.
– In the setting, it is shown that a comparison of country and evaluation of new methods is assumed. It is also pointed out that Denmark draws inspiration from Norway when it comes to method evaluations?
– But this is about the decisions. In Denmark, more people are involved than those who sit on the money bag and must be good to the Minister in delivering results in the balance sheet. Users and professionals must be represented to a greater extent. It is not the case that we say that we must go for the Danish solution at all costs, but more people must be involved in the decisions. This is not about the method evaluations.
– Must go by itself
Conservative politician Tone Wilhelmsen Trøen does not recognize himself in the criticism from Bård Hoksrud.
– Frankly. Here I think Hoksrud should go by itself. What the FRP is proposing is a completely new model. It will take a long time. We now have a recent evaluation report. The quickest thing we can do to hire new doctors earlier is to follow up on the points the report points to.
She points out that the Conservatives actually also support some of the proposals the Progress Party comes up with.
– We are the only ones in the proposals that apply to a review of the exemption scheme and the proposal for a quality-assured method evaluations.
Trøen points out that the Storting has also previously considered a case concerning Proba’s report.
– Then we did not receive support from Frp for increased user and clinic evaluation, nor that the drug policy goals should be weighted equally.
She points out that the Conservatives have asked the government to come back with an update on how the evaluation is followed before the end of the year.
– The safest thing we can do to not lag behind is to follow up the points for Proba. But then we must also not forget that the evaluation report also showed that there is broad support for models.
– Disappointed
– We are disappointed that the health committee does not support the proposal. The patients deserved better, says the Cancer Society’s general secretary Ingrid Stenstadvold Ross to Dagens Medisin.
The association took the initiative for what is referred to as the “Patient Call”, a signature campaign that requires quick access to new treatment. 41 patient organizations are behind the appeal, which has now collected over 80,000 signatures.
– This is a public outcry that can not be ignored, the Secretary General believes.
More review of exemption scheme
One of the proposals in the representative proposal, which receives broad support, is a proposal to review the current exemption scheme. That was one of the recommendations in the evaluation for Proba.
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Ross is pleased that several parties are in favor of this.
Today, the main rule is that treatments and medicines that are assessed by the Decision Forum cannot be used while assessments are in progress. It is still an opening for exception. This can be done at group level by subject directors in the regional health authorities making a decision. Or it can happen at the individual patient level, by the individual health trust making a decision.
– We notice that a large minority in the health committee wants a review of the exemption scheme as Proba also recommends, and that almost the entire Storting expects something to be done with this before the priority report is available, says the Secretary General.
– Now Kjerkol must come on the field, and take this ball with both hands. Patients can no longer wait.
Ross believes that today’s exemption scheme does not work.
– We support the principle that medicines used in Norway must be available to everyone. We also understand that it can take time to negotiate the right price for the masses. But we must put in place an exception scheme that gives the sickest patients access to doctors while we assess which drugs we should prioritize within the set health budgets, she says.
– Our message to politicians is clear: Order a review of the exemption scheme now.
A «special focus»
The committee members from the Conservative Party, the Progress Party, the Christian People’s Party and Patient Focus believe that the current exemption scheme does not work as intended and must be reviewed.
“Several medicines are rejected without patients or experts having the opportunity to shed light on the matter”, it is stated in the recommendation and it is described as “very unfortunate that the exemption scheme only works during the period the medicine is being considered in the Decision Forum for new methods”.
The Labor Party and the Center Party’s committee members do not support the proposal, but write the following:
«The committee members from the Labor Party and the Center Party to the evaluation report from Proba, and notes that they believe that it can be beneficial to carry out a more thorough review and revision of the criteria for exemption which was carried out in 2018. These members are the only minister in it is natural that this is discussed in the announced report to the Storting on prioritization ‘.
The committee members point to the priority report, but at the same time point out that it is «important to ensure that the exemption scheme is in line with the intention in Meld. St. 34 (2015–2016) to ensure fair access to health services »and that they expected« a special focus »on the scheme in the time before the prioritization report is available.
When Dagens Medisin interviewed Minister of Health and Care Services Ingvild Kjerkol recently, she said that she “opens up to look at” the scheme.
– Should go fast
Bård Hoksrud in Frp, who himself has proposed to review the exemption scheme, is not very happy that several parties are positive about this.
Review and review. Now we need to do something to make sure we get access faster. That is our starting point.
Tone Trøen in the Conservative Party believes that there is a need for the review to start quickly.
– This is a clear signal. But the clearest signal would be a majority in the Storting. When there is no majority for the proposal, it is uncertain how the government will follow it up.
The Storting will vote on the proposal on 9 June.