Cancer doctors accuse insurers of denying patients access to new drugs

Private health insurers Irish Life and Laya are “hiding behind” the lengthy process for approving drugs and denying patients access to proven cancer treatments, according to two leading oncologists.

By refusing to reimburse the drugs recommended by patients’ doctors, the two companies are effectively forcing patients to use inferior treatments, Prof Ray McDermott and Prof John Crown say.

Prof McDermott says he is “totally frustrated” at the refusal of Irish Life Health and Laya Healthcare to cover the cost of new cancer treatments for patients when VHI funds them.

“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 until a price has been agreed in the public system, and that can take over two years. A lot of patients will be dead by then.”

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As a result, he says, patients with advanced cancer resort to desperate means when their access to immunotherapies is blocked – by paying for the drug themselves, fundraising or “robbing the family of their estate”.

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

According to Prof McDermott, VHI generally reimburses a new drug within one or two months of it being clinically approved by the European Medicines Agency (EMA). In contrast, Irish Life and Laya wait until Irish authorities make a decision on reimbursement in the public system.

The Health Service Executive (HSE) funds scores of expensive new-generation therapies to treat different cancers, but each new use of an existing drug to treat a specific cancer must be assessed on cost-efficiency grounds. This process is often followed by a lengthy period of price negotiation with the manufacturer before a decision is made.

Ireland is second worst in Europe for access to new cancer drugs, Prof McDermott says.

“It takes on average two years from the time a drug is approved by the EMA to when we can prescribe it for our patients. Only Portugal takes longer,” he said.

Having health insurance with Laya or Irish Life puts you at a “serious disadvantage” if you have cancer, he says. “It is very frustrating when we are trying to do our best for patients.”

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Prof Crown says there is now a “substantial gap in coverage” for cancer treatments between the VHI and its two rivals.

“It is very unfortunate that our already regrettable two-tier healthcare system is now becoming a three-tier system. It is regrettable too that private insurers are refusing to make drugs available to their clients which have been approved at European level,” he said.

“People who are choosing what health insurance company to join or who are existing members of insurance companies need to be aware that there is now a very substantial difference in access to modern cancer treatments in favour of VHI compared to the other two companies.”

The former senator points out that he and other oncologists do not stand to benefit if patients are approved for treatments.

“I have no economic interest in this one. If I can’t get the drug that’s paid for by the company, I will give them something else and get paid exactly the same. The only difference is that it doesn’t work as well,” he said.

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VHI accounts for about half of the private health insurance market, with the remainder fairly equally shared between Irish Life and Laya. Irish Life last week announced a premium increase, the second this year.

Irish Life says it funds treatments approved by the National Centre for Pharmacoeconomics, the National Cancer Control Programme or the HSE.

Laya said it accepted “the guidance and direction” of the NCCP, the NCPE and the HSE, “in consultation with medical consultants involved in the treatment of patients”.