This should give improved treatment options for cancer, eye and autoimmune diseases, as well as for mental health issues, and affects a wide range of patients, from just a handful of sufferers in some cases, to over a thousand in others.

The list has been expanded to include the drug Ryjunea (active substance atropine sulfate), intended to stem the progression of myopia, or nearsightedness, in children.

"The prevalence of myopia has seen a manifold rise in recent decades, due to factors related to modern lifestyles. The condition typically develops in early school age and progresses as the child grows. The earlier it starts, the more severe the visual impairment may become in adulthood, which in turn increases the risk of eye diseases later in life. The medication helps slow the progression of myopia and reduce the risk of developing more serious eye conditions," said Getter Hark, head of the Health Insurance Fund's reimbursement service for medicines.

Up to 300 patients per year are expected to benefit from the drug's wider availability in retail pharmacies in Estonia. Compared with the existing medications issued by hospital pharmacies, Ryjunea is more convenient for patients to use. Its use will cost approximately €150,000 per year.

Another important medication introduced since April is Jakavi (active substance ruxolitinib). This drug is used to treat graft-versus-host disease in patients for whom previous treatment has not been sufficiently effective. "Graft-versus-host disease can occur after a bone marrow or hematopoietic stem cell transplant, when the transplanted immune cells begin attacking the patient's body, causing inflammation and damage in various organs. The medication helps reduce the immune system's response and improves the patient's well-being," Hark said. A far smaller number of patients, around half a dozen, require this medicine per year in Estonia.

This month has also brought an update in the treatment of patients with attention deficit hyperactivity disorder (ADHD). The reimbursed medicines list now includes Tentin (active substance dexamphetamine), which is used as an alternative treatment option for both children and adults. "ADHD is a neurodevelopmental disorder in which a child has difficulty concentrating, staying still, or controlling their behavior. It can affect both school performance and daily functioning. Treatment helps improve attention and reduce impulsivity, and is part of a comprehensive approach that also includes mental health counseling and support services," said Hark.

New treatment options have also been added for patients with psoriatic arthritis and giant cell arteritis, as well as the immunoglobulin Hyqvia for replacement therapy in immunodeficiency and a medicated nail lacquer for the treatment of fungal nail infections.

Updates to hospital medicines

The Health Insurance Fund has also expanded the list of drugs available in hospitals to include several innovative drugs which improve treatment options for patients with severe and rare diseases.

A new option has been added for the treatment of neovascular age-related macular degeneration – the macula is a small area at the center of the retina responsible for sharp, detailed central vision and color perception – for patients whose current treatment options have been exhausted. This is a common condition in older people and leads to vision loss. Sufferers may have difficulty seeing up close, recognizing faces, and driving. The medication Vabysmo (active substance faricimab) is estimated to be needed by around 1,000 patients per year, with patient numbers steadily increasing due to population aging.

A new hospital medicine has also been added for the treatment of neuromyelitis optica spectrum disorder. In this disease, the immune system attacks the central nervous system, particularly the optic nerve and spinal cord. This can lead to vision impairment, mobility difficulties, and permanent disability. The medication is important for patients whose previous treatment has not been sufficiently effective. In Estonia, there are reportedly five patients for whom the drug Ultomiris (active substance ravulizumab) helps slow disease progression and reduce the risk of nerve damage.

The hospital medicines list also now includes Libtayo (active substance cemiplimab) for the treatment of advanced non-small cell lung cancer and Eylea (active substance aflibercept) for the treatment of retinal disease in premature infants.

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