Rivals have no plans to follow VHI’s decision on cancer drugs

Commercial rivals to the VHI say they have no plans to follow the semi-State health insurer’s lead by providing wider access to cancer drugs for some private patients.

Laya Healthcare and IrishLifeHealth say they will continue to accept the guidance of the National Cancer Control Programme (NCCP) and the National Centre for Pharmacoeconomics and the HSE in relation to the approval of new drugs.

Last week VHI wrote to oncologists saying it would provide wider access to cancer drugs, including Pembrolizumab, for stage three melanoma, and Pertuzumab (Perjeta) for patients with early stage breast cancer. The move is seen as disrupting the traditional equality of access for public and private patients for such treatments.

Providing the same level of access for public patients would cost up to €100 million over five years, according to Prof Michael Barry of the NCPE, who said the change raised questions of equity between public and private patients.

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However, the wider access will apply only to VHI patients in private hospitals, and not to private patients insured by the company who are being treated in public hospitals.

Before drugs are approved for public patients they must be assessed by the NCPE, which provides reports on the cost effectiveness of funding new drug treatments for the HSE. While assessments are completed within months, the process of approving new drugs, or new application for existing drugs, is often subject to lengthy delays.

‘Laggard’

Laya said it covers the use of drugs including Pembrolizumab, Nivolumab and Pertuzumab for members being treated for advanced melanoma, breast cancer and lung cancer.

“We welcome the recent review by the NCPE regarding the reimbursement of Pembrolizumab, Nivolumab and Pertuzumab for clinical indications of early-stage cancer treatment in public hospitals, and as with all ongoing advances in medicine and medical technology, where standards of care evolve and change, we will amend cover of treatment and procedures in consultation with our own medical advisory board, where appropriate.”

Labour Party health spokesperson Alan Kelly claimed Ireland continues to be a laggard for providing oncology medicines to patients on public waiting lists.

“The fact that oncologists across the country have received notice from private health insurers that they will be [providing] funding to oncology drugs to private patients in private hospitals shows the levels of inequity that exist in our health service.

"Currently, there is a 623-day wait from when new oncology medicines are approved by the European Medicines Agency and when they come on to the Irish market. Compared to a 124-day wait to our colleagues in the United Kingdom, Ireland is seriously lagging behind in the provision of treatment."