More than fifteen Moroccan families suffer from the high price of a drug treating cases of metastatic cancer and which costs them the modest sum of 23,000 DHS per month. A drug that is unfortunately not reimbursable by the National Health Security Fund (CNSS).
After finding out about the procedure to follow in this case, these families found a way to make their voices heard by initiating a procedure with the National Health Insurance Agency (ANAM).
” We contacted the ANAM by compiling a file with a report of the cases, the doctors’ prescriptions, why we need this particular medicine, the necessary analyses, etc. We were told that if the file fulfills all the administrative conditions, it goes before a medical committee which gives its agreement for the drug to be reimbursed thereafter.“, tells us the son of a woman with metastatic breast cancer.
After submitting their file to ANAM, these families thought that the procedure would take 3 to 4 months maximum, knowing that they would continue to pay the 23,000 DHS/month to obtain the drug. Kisqali in addition to cancer-related costs. But in vain.
” The laboratory that makes the drug available in Morocco (Novartis) assured us that they had submitted all the necessary documents to ANAM and had started the procedure, and that the drug should be reimbursed soon, but it is a question of administrative procedures. . But we were surprised to receive a document from ANAM’s legal services prohibiting us from going through this commission.“, explains our interlocutor.
Indeed, according to the document sent to these families and whose MoroccoLatestNews UK holds a copy, ANAM requires other documents from the families, in particular a copy of the medical report dated, stamped and signed by the attending physician justifying the use of the drug KISQALI, noting that there is ” another therapeutic alternative reimbursable under the basic AMO, namely the DCI: PALBOCICLIB“. What the attending physician refused to do.
” We are asked to change the doctor’s prescription, while these patients have been on this treatment for months. In addition, this alternative drug does not have the same molecule as Kisqali. We tried to join ANAM. We wrote to them, as well as the doctors treating these patients to ask for explanations. But in vain“, says our interlocutor.
Feeling ” abandoned“These patients just want to enjoy their right and get through these commissions, to have fair treatment. Because, he tells us, about ten other patients followed this process, and obtained the agreement for other drugs”.
ANAM explains itself
Joined by MoroccoLatestNews UK On the case of these patients with metastatic cancer, an official source at ANAM told us that the agency is indeed the last resort for patients who want one of the drugs prescribed to them, for life for some, and which is expensive, be reimbursed by the CNSS.
” For drugs that do not appear in the Guide to Reimbursable Drugs (GMR), which is updated according to new technologies and new drugs that arrive and their usefulness, the legislator has opened a small breach for citizens through a claim for recourse to ANAM to re-examine the file concerning this drug which does not appear in the GMR“, explains our source.
ANAM collaborates in these cases with two commissions. The first is that of transparency, whose president is appointed by the Ministry of Health, and which is completely autonomous and where professors and researchers sit. The second is the economic and financial one of health products.
Not having the ” regulatory force” to include a drug in the GMR, ANAM thus requires a request from the laboratory formulated in this sense, so that the Agency can submit it to the Transparency Committee to rule on the actual benefit rendered.
” The medical service rendered, once favourable, ANAM submits it to the Economic and Financial Commission for Health Products. It is a commission made up of representatives of the managing bodies, researchers, epidemiologists, health economists, public health people from ANAM, the Ministry of Health, in particular the medicines department.“, explains our interlocutor.
Subsequently, the said commission examines the impact of the drug in relation to its added value, to the medical service rendered, but also measures the impact on the funds. If the opinion is favourable, the ANAM submits the opinion to the Minister of Health who signs an order to integrate the drug into the GMR, our source confides to us, noting that any existing drug in the GMR goes through this procedure which is very well codified, regulated and transparent.
But the families who called MoroccoLatestNews UK claim to have followed this procedure to the letter, but still do not manage to see their case go before these commissions. In response to this question, our source explains that “ when ANAM receives the complaint, and thanks to an agreement signed between the Agency and the five University Hospitals of the Kingdom, it refers to the multidisciplinary consultation commission which sits at the level of the University Hospitals“.
” Once the complaint file is at the ANAM, it does not exceed 48 hours before being submitted to the commission, anonymously, telling them that there is a drug that does not exist in the GMR, but that A prescriber deemed it useful to prescribe it to his patient, asking for their opinion on the relevance of this request. Once the file has been sent to the commission, we wait for the opinion. If the opinion, processed within 15 days, is favorable and the drug can be waived, the ANAM director signs the request“, we are told.
Asked about the alternative medicine offered to his patients and which is reimbursable, but which does not correspond to the same molecule prescribed by doctors for months, our source within ANAM tells us that ” the derogation is precisely subject to this complicated circuit, to benefit the patient if it is a drug useful for his health, but also to rationalize the prescription and make it within the framework of science“.
” If we open the door to reimbursement for all drugs that are expensive, there will be a haemorrhage of prescriptions which can lead to the collapse of funds. We respect the prescription of all doctors. But when it comes to a multidisciplinary consultation, that is to say a dozen teachers who meet and examine the patient’s file, even summoning him in certain cases, and asking for additional examinations, it is precisely to have a clean heart in relation to this prescription“, says this source within the ANAM.
” A single doctor can judge that it is relevant to prescribe such a drug to such a patient. But when a community of researchers, of professors come together around a file and give it the necessary interest, and say that this drug is not useful and that the patient can use another one, the director trust them. Because based on their conclusion, the director of ANAM makes his decision“, we are told.