Israel had 2.5 billion shekels worth of drugs worth funding and 650 million to spend

Israel's committee for deciding what the national health system covers reviewed more than 600 submitted drugs for 2026, narrowed them to a shortlist worth 2.5 billion shekels, and had 650 million shekels — about a quarter of that — to actually spend [s2]. What made the final list, and what didn't, shows how a fixed annual budget forces real tradeoffs even among treatments a committee has already judged worth funding.

What actually made it into the 2026 basket

Oncology took the largest share: 337 million shekels, or 52% of the total budget, went to cancer treatments including Cabometyx for pancreatic cancer, Keytruda for head and neck squamous cell carcinoma, and Imfinzi for muscle-invasive bladder and stomach cancer, alongside expanded coverage for colon cancer, multiple myeloma, lymphoma, leukemia, and prostate cancer [s2]. The basket also added acupuncture for chemotherapy patients — a first-time inclusion for that treatment — plus early-detection tests for breast and lung cancer, expanded genomic profiling for gastrointestinal malignancies, and preimplantation genetic testing for BRCA1 and BRCA2 mutations [s2]. On mental health, the basket added Reagila as a first-line major depressive disorder treatment, Auvelity for more advanced depression, and guanfacine for ADHD in children and adolescents — a drug expected to reach roughly 1,450 patients [s2].

What got left out, and why the reasoning matters

Two rejections stand out because the committee's stated reasoning was explicitly about cost relative to the fixed budget, not efficacy: Leqembi, an early-stage Alzheimer's treatment that would have cost approximately 58 million shekels, and Kalsody, an ALS treatment for a specific genetic mutation priced at roughly 700,000 shekels per patient [s2]. Neither rejection is reported as a finding that the drug doesn't work — the basket committee's process weighs clinical evidence against a capped budget, and a drug can clear the clinical bar while still losing out to other treatments that deliver more benefit per shekel across a larger patient population. That's the mechanical reality underneath the 2.5-billion-versus-650-million gap: real clinical need existed for more than three times what the budget could fund.

The political instability that delayed the whole process — twice

This committee's timeline was disrupted at two separate points. Its initial appointment was delayed for weeks in late 2025 because Israel lacked a sitting health minister after MK Haim Katz failed to win government approval for the role [s1] — the committee wasn't even formally constituted until 16 November 2025, holding its first working session four days later [s1]. Then, separately, the committee's actual recommendations arrived nearly three months late, a delay the reporting attributes to continued coalition instability and the health minister's resignation in July [s2]. Two distinct ministerial vacancies disrupting one budget cycle is a strong signal of how directly Israel's governing-coalition turnover translates into concrete delays for patients waiting on coverage decisions, not just abstract political noise.

What this doesn't tell you

The available reporting doesn't specify exactly when in 2026 patients could actually begin accessing the newly added drugs — a basket addition is a coverage decision, not necessarily an immediate access point, and implementation timelines for newly approved treatments can vary. It also doesn't detail the full list of what was submitted but didn't make the 2.5-billion-shekel shortlist in the first place, so it's not possible to say how the shortlisted treatments compared to everything that was originally proposed.

What to watch next

Whether the roughly 1,450 patients expected to access guanfacine and the broader group covered by the new oncology additions see coverage translate into actual treatment within 2026, and whether the pattern of ministerial-vacancy delays recurs in the next budget cycle — this is now the second consecutive disruption to this specific committee's timeline within a single cycle.