When treatment works, access still matters.

Breast cancer survivorship is increasingly understood as a form of chronic condition management. Rather than marking the end of illness, treatment often marks the beginning of long-term adaptation. This reflects a key distinction between disease and illness: while treatment targets the disease, patients continue to live the illness, managing ongoing physical and emotional challenges. This also aligns with a broader understanding of health as the ability to adapt to long-term conditions (Huber, 2015).

During treatment, care may appear highly effective from a biomedical perspective. In HR+/HER2 (metastatic breast cancer), CDK4/6 inhibitors such as palbociclib, ribociclib, and abemaciclib have become established targeted therapies in the Netherlands, with research showing that these medicines have reached many eligible patients in clinical practice (Luyendijk et al., 2023).

However, access to treatment is not determined by clinical effectiveness alone. In 2025, Dutch insurers restricted full reimbursement to one of the three CDK4/6 inhibitors, while limiting coverage for the other two, raising concerns among patients and oncologists about forced switching and unequal access to treatments that were already effective for some patients (NL Times, 2025a). The dispute led to legal action. The District Court of Gelderland ruled that insurers had to stop this preferential policy, and court records indicate that Novartis, Pfizer, and Eli Lilly were all involved in the procurement process (Rechtbank Gelderland, 2025; NL Times, 2025b).

This case shows that even when treatment exists and works, patient access remains shaped by pricing, reimbursement, and insurer policy.

Reference

Huber, M., Knottnerus, J. A., Green, L., van der Horst, H., Jadad, A. R., Kromhout, D., Leonard, B., Lorig, K., Loureiro, M. I., van der Meer, J. W. M., Schnabel, P., Smith, R., van Weel, C., & Smid, H. (2015). How should we define health? BMJ, 343, d4163. https://doi.org/10.1136/bmj.d4163

Luyendijk, M., et al. (2023). Real-world uptake of CDK4/6 inhibitors in metastatic breast cancer in the Netherlands. https://ris.utwente.nl/ws/portalfiles/portal/301678330/luyendijk_2023_oi_221601_1675800345.43295.pdf

NL Times. (2025a, February 18). Dutch health insurers no longer fully cover 2 breast cancer meds; patients devastated. https://nltimes.nl/2025/02/18/dutch-health-insurers-longer-fully-cover-2-breast-cancer-meds-patients-devastated

NL Times. (2025b, February 26). Health insurers worried after court order to cover expensive cancer meds. https://nltimes.nl/2025/02/26/health-insurers-worried-court-order-cover-expensive-cancer-meds

Rechtbank Gelderland. (2025). ECLI:NL:RBGEL:2025:1468. https://uitspraken.rechtspraak.nl/details?id=ECLI:NL:RBGEL:2025:1468