120,000 shekels a month: all the details on the new pancreatic cancer drug

The US Food and Drug Administration (FDA) announced unexpectedly last week the approval of the drug Rasonque for the treatment of metastatic pancreatic cancer. The drug, developed by Revolution Medicines, was received with enthusiasm by the market. In the last year alone, Revolution Medicines' stock has jumped by 477% following positive news regarding the drug. However, many questions arise after the announcement—from the drug's cost to its accessibility for Israeli patients.

A breakthrough for patients

The drug does not offer a cure, but for pancreatic cancer patients, for whom treatment options have been very limited, it provides an opportunity for significant life extension (from about 6 to about 13 months on average in company trials) and improved quality of life. The trial was conducted on patients in an advanced state, and there is hope that if the product is prescribed at an earlier stage, it will be even more effective. Revolution is already conducting trials for the drug as a first-line treatment.

Accessibility in Israel

Patients in Israel will likely not find it difficult to obtain the drug, but paying for it will be a complex challenge. The drug is not yet registered for marketing in Israel, but patients can import it personally through Section 29c, which allows importing any drug that has received FDA approval. There are pharmacies that specialize in the personal import of such medications.

However, personal import is done at full price. The drug is expected to be sold in the US at 40,000 dollars a month, about 1.4 million shekels a year. Private insurance policies today include coverage for drugs outside the basket of 3 million shekels for two years, which should cover this drug. However, coverage from older policies is sometimes lower, and patients often need more than one drug outside the basket.

Regarding official import, at least four Israeli pharmaceutical companies have approached Revolution, but the Israeli market is not a high priority for the company at the moment. Inclusion in the national health basket is unlikely before 2028.

The stance of insurance companies

Prof. Ido Wolf, Director of the Oncology Department at Ichilov Hospital, estimates that about 500-600 patients in Israel are eligible for the drug immediately. This involves an immediate payment of hundreds of millions of shekels. Total expenditure by insurance companies on drugs outside the basket likely reaches several billion shekels.

"We doctors will want to give this drug to patients with other types of cancer with RAS mutations because the mechanism is the same," says Wolf. "In such a case, we are reaching an expenditure of a billion shekels or more a year. Insurance companies will have several options: raise policy prices, demand that the Commissioner of Insurance limit coverage, or tighten eligibility conditions."

Market potential

Analysts at the investment bank RBC estimated the drug's peak potential at about 11.8 billion dollars. Last January, Merck wanted to acquire Revolution for 28-32 billion dollars, but the deal did not go through. Today, its market value is 44 billion dollars. Despite a 6% drop in stock on Friday, the company has recorded gains of more than 400% for the year.