Laya and Irish Life customers to get faster access to cancer drugs following policy U-turn

Two private health insurers have promised to make innovative new cancer drugs available more quickly to patients, in a significant U-turn in policy.

Irish Life Health and Laya Healthcare say they will provide cover for the treatments as soon as the drugs are clinically approved by the European Medicines Agency (EMA). Up to now, they have generally waited until the HSE decides to reimburse the drugs for public patients, a process that can take several years.

The two companies’ change of heart follows revelations in The Irish Times earlier this month of the substantial gap between the cover they provide for cancer patients and that provided by VHI Healthcare, which funds the treatments once the EMA has approved them.

Leading oncologists Prof Ray McDermott and Prof John Crown accused Irish Life and Laya of “hiding behind” this lengthy process for approving drugs and denying very sick patients access to proven treatments. The two companies account for about half the private health insurance market.

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Laya was “accelerating the approval pathway” for new cancer drugs following a 12-month review of policies and benefits, the company told hospitals in a letter seen by The Irish Times.

While continuing to “accept the guidance” of the National Cancer Control Programme (NCCP) and the National Centre for Pharmacoeconomics (NCPE), it will now cover new, innovative medicines as soon as they have been approved by the EMA.

Cover will be subject to pre-authorisation, meeting clinical criteria and will be reviewed on a case-by-case basis, the company says.

Irish Life had reviewed its current processes to assess ways to speed up patients’ access to drugs not currently approved by the HSE, NCCP or NCPE, the company told The Irish Times.

“On foot of this review, Irish Life Health has decided that it will cover patients for high-cost cancer drugs that have received approval from the EMA,” it said. “Decisions on individual cases will be taken on a case-by-case basis, in consultation with an independent panel of clinical experts who will advise on clinical effectiveness and patient safety.”

Prof McDermott said he was delighted by the change in policy by the two insurers. Mary O’Loughlin, a cancer patient from Boolavogue, Co Wexford, also welcomed the news. She has been unable to access immunotherapy because the drugs Prof McDermott recommends are not funded by the HSE or Irish Life.

Ms O’Loughlin, who has a rare form of gastric cancer, has been given a sixth round of chemotherapy instead and is awaiting a scan to see how that has impacted her disease. “At least I know it’s on the way,” said Ms O’Loughlin, whose renewed application for access to immunotherapy was refused by Irish Life as recently as two weeks ago.

The changed stance by insurers means public patients are seriously disadvantaged due to the length of time the HSE reimbursement process takes. This is due to the number of intermediate steps involved and the length of time behind-the-scenes price negotiations with drug manufacturers take.

While both Irish Life and Laya maintain they refused only small numbers of patients, Prof Crown said this was because oncologists knew their applications for cover would be refused so there was “no point” in applying for it.