Paul Cullen: What prompted Irish health insurers to make innovative new cancer drugs available to subscribers?

It’s not often that a business offers new benefits to its customers, but doesn’t rush to tell them. This has just happened with two companies accounting for half the health insurance market.

Irish Life Health and Laya Healthcare have both decided to make innovative new cancer drugs available to subscribers, though it took a query this week from The Irish Times to establish what was happening.

Using similar language to one another, the insurers separately issued statements explaining that, following a 12-month review of policies, they had decided to make high-cost cancer treatments available to patients once they have been approved by the European Medicines Agency (EMA).

This could shave up to two years off the length of time seriously ill cancer patients, otherwise running out of options, have to wait for access to these medicines.

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The two companies have been on the back foot for the past month, since The Irish Times highlighted the yawning gap between their policies on access to cancer treatments, and the policy of the VHI.

Cancer medicine is undergoing a revolution, with scores of new treatments targeting specific tumours on the way. Thanks to the internet, patients can keep abreast of the latest options for treating their cancer in leading centres in the US and elsewhere.

In 2019, VHI took stock of these developments and decided to fast-track availability of these drugs for their patients. These immunotherapies are expensive but are particularly sought-after by patients who have run out of road with existing treatments.

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.

[ ‘Extremely unfair’ - the imbalance in health insurance cover for life-changing cancer drugs ]

Over time, the number of new drugs, and the number of indications of these drugs for different cancers, has multiplied. Oncologists, already used to waiting long periods before cancer drugs were approved for public patients, found that even for their private patients, access varied hugely between different insurers.

“Patients know these drugs exist. They are proven. They’ve been approved on clinical grounds by the regulatory bodies. But we can’t use them [on Irish Life and Laya patients] until a price has been agreed in the public system, and that can take over two years,” Prof Ray McDermott told me. “A lot of patients will be dead by then.”

In desperation, patients and their families resorted to paying for the drugs themselves or through organising fundraisers, he said.

Along with other colleagues, Prof McDermott grew increasingly frustrated at the unfairness involved in delays. His point was illustrated by the case of Mary O’Loughlin, from Co Wexford, who had been unable to access immunotherapy he recommended because it not funded by the HSE or her insurer, Irish Life.

Ms O’Loughlin has a rare form of gastric cancer and has undergone extensive chemotherapy and surgery. The drugs Prof McDermott wants to administer are already indicated for other, more common cancers; her treatment would be funded if she had the same form of cancer in the colon rather than in the stomach.

Both Prof McDermott and Prof John Crown had accused Irish Life and Laya of “hiding behind” the lengthy process for approving drugs for public patients by holding off on funding until the HSE had agreed to reimbursement.

[ The Irish Times view on health insurance coverage for key cancer drugs: unwelcome gaps ]

Both companies had referenced the National Centre for Pharmacoeconomics (NCPE) in their decision to withhold funding for the drugs. Yet the NCPE’s sole role is to evaluate the cost-effectiveness of medicines for the State, not to adjudicate on how well they work. Cost-effectiveness will always be determined by price, which is why recommendations by the NCPE on any drug are always followed by (often lengthy, always secret) price negotiations between the HSE and the manufacturer. The unspoken approach by the State is to delay in the hope the price asked for will fall over time.

Almost half the population has private health insurance, and half of those people are customers of Irish Life and Laya, so the companies’ U-turn will be significant for many patients. That still leaves the wider disparity in access between public and private patients, one that is replicated across the health service.

According to a European pharma industry group, it took on average 567 days from EMA authorisation to availability to patients last year of new innovative medicines in Ireland. That was among the slowest in western Europe, and 100 days longer than it took three years earlier.

[ Insurers blocking cutting edge cancer drugs is not a good look ]

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

Minister for Health Stephen Donnelly did agree to set up a working group to see how greater transparency and better communications with patients could be effected.

The consultants’ report was published three years after it had been completed, nothing more has been heard of the working group and Mr Donnelly says his officials will complete consideration of its recommendations “when resources permit”.