HealthAnalysis

Why are new cancer drugs available to private patients but not public patients?

The approval for the public system is a long process, entailing between 20 and 30 steps depending on the medicine, according to the Irish Pharmaceutical Healthcare Association

The Health Service Executive is responsible for decisions regarding the reimbursement of new drug technologies. Photograph: iStock

Shauna Bowers's face
Shauna Bowers Health Correspondent
Mon May 20 2024 - 06:02

In 2019, VHI became the first Irish health insurer to cover the cost of novel cancer drugs for cancer patients once they had been approved by the European Medicines Agency (EMA).

At the time, Irish Life and Laya chose not to follow suit, sticking to their policy of waiting for the drugs to be funded under the public system before agreeing to pay for them for their customers.

However, in a big U-turn last summer – following coverage of the gap between the policies by The Irish Times – the two private insurers announced they too would provide drugs once they had EMA approval.

This was a widely welcomed move, with oncologists stating it provides them with increased treatment options for many patients in the private health sector.

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However, this now means there is a gap in the availability of cancer drugs – which are often incredibly expensive but highly sought after – between public and private patients.

The Health Service Executive (HSE) is responsible for decisions regarding the reimbursement of new drug technologies. The approval for the public system is a long process, entailing between 20 and 30 steps depending on the medicine, according to the Irish Pharmaceutical Healthcare Association (IPHA). Figures from the IPHA said it is currently taking an average of two years between EMA and HSE approval.

Prof Michaela Higgins, a consultant oncologist at St Vincent’s University Hospital, and current president of the Irish Society of Medical Oncology (ISMO), said a decade ago the time between EMA approval and HSE approval was much shorter.

[ Ireland’s two-tier cancer drug system: ‘I can give one drug to one lot of patients, not to another’ ]

However, the “avalanche of new and very sophisticated oncology drugs”, as well as resourcing in the National Centre for Pharmoeconomics (NCPE) has resulted in these delays, she said.

During the approval process, the HSE asks the NCPE to evaluate the cost-effectiveness of a medicine, determined solely by price. This is why recommendations by the NCPE on any drug are followed by lengthy and secret price negotiations between the HSE and the manufacturer.

Robert Watt, secretary general of the Department of Health, recently said expenditure on expensive new drugs was “not sustainable”, with spending on medicines having increased from €1.3 billion in 2012 to €3.2 billion last year.

A recent plan unveiled by Minister for Health Stephen Donnelly seeks to bring in savings across various areas of the health service, including a target of €20 million in savings on medicine this year.

In a report published in February 2023, Department of Health consultants found the HSE process for funding medicines was operating in line with legislation and delivering results “in keeping with international norms”.

Following the report, Mr Donnelly set up a working group, which is focused on considering the recommendations outlined in the report.

Speaking at the IPHA conference earlier this year, Mr Donnelly said the working group’s final report was near completion, and 13 of the 17 recommendations would be progressed, including work around transparency, patient involvement and the introduction of a medicines reimbursement application tracker.

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