Insurers blocking cutting edge cancer drugs is not a good look

Blocking treatment for members when you are a private health insurer is not a good look, especially when your biggest rival is name-checked as being more accommodating.

That is the very uncomfortable position the two challengers to VHI in the Irish market – AIG-owned Laya Health and Irish Life Health – find themselves in after a withering attack from two clearly frustrated and high-profile oncologists, Prof Ray McDermott and Prof John Crown.

Noting that cancer will affect one in three Irish people in their lifetimes, Prof McDermott said having health insurance with Laya or Irish Life puts consumers at a “serious disadvantage” if they have cancer.

“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,” Prof Crown said.

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The consultants have a point when they accuse the insurers of “hiding behind” the lengthy process for approving drugs. The delay of up to two years or even more is essentially an extended bout of horse-trading over price between the State and the individual pharmaceutical companies on drugs already approved by the EU regulator, the European Medicines Agency. There is nothing to stop private insurers accepting a different price, even if only pending the conclusion of those discussions. VHI clearly has.

[ Cancer doctors accuse insurers of denying patients access to new drugs ]

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

The timing is particularly unfortunate for Laya, given that US insurer AIG had decided to put the Cork-based business up for sale with a price tag of €160 million-€200 million.

The insurer’s 675,000 customers are the key attraction to buyers and hearing a high-profile oncologist advise them to jump ship to their bigger rival will be unsettling for potential suitors and could yet undermine the price AIG can achieve for the unit.

Of course, costs are a sensitive issue for all companies including insurers. Irish Life Health only last week announced a second rise in premiums this year – amounting to about 10 per cent – citing “a very significant increase in the volume and size of claims” and “substantial medical and general inflation”.

But the company’s reference to the requirement for high-cost pharmaceuticals to deliver the best health outcomes for patients might ring somewhat hollow to its 490,000 odd patients as they weigh the consultants’ words and consider whether now is the time to review their options.