A leading cancer specialist has expressed concern that some patients with private health cover are facing delayed access to vital new oncology medicines.
Consultant oncologist at St Vincent's Private Hospital Professor John Crown said that patients who have cover with Laya Healthcare or Irish Life may have to wait two years or more in cases, to get access to newer cancer treatments, but may wait just a few months with VHI cover.
He said these patients are those with advanced cancer.
Prof Crown said that the VHI usually covers the drugs a few months after they have been clinically approved by the European Medicines Agency.
Laya and Irish Life are guided by the Health Service Executive approvals system for covering these drugs for public use through the National Cancer Control Programme or the National Centre for Pharmacoeconomics.
In a statement, Laya Healthcare said that there are times when it will approve these drugs earlier than HSE-led approvals, where the treatments have been approved by the EMA and are supported by medical evidence.
It said that of the tens of thousands of cancer-related claims it covered last year, it received 33 exceptional requests from consultants to cover treatment outside its approved schedule. The company said it approved over a third of the requests.
"The remainder were not approved for a variety of reasons, including that the therapy was not approved by the European Medicines Agency (EMA) or that the drug combination requested had not gone through a clinical trial and so was unproven.
" These decisions are made in the best interest of patient safety and overseen by our clinical and Medical Advisors, " Laya Healthcare added.
Prof Crown said the issue means some patients have to fund the cost of the drug themselves.
Public patients can access these new cancer medicines once they are approved by the HSE system for reimbursement and have been approved by the European Medicines Agency.
Irish Life Health said it funds treatments that have been approved by the National Centre for Pharmacoeconomics (NCPE), the National Cancer Control Programme (NCCP), or the HSE.
It said that this is an independent, expert-led way to assess the benefits of new treatments for specific conditions based on clinical evidence.
In 2022, 97% of requests from Irish Life Health customers for cover for high-cost drugs and new treatments have been approved and funded by Irish Life Health based on this process, it added.
Director of Advocacy with the Irish Cancer Society Rachel Morrogh called for fairer access to treatment across the health system and said this example is just one feature of the wider system of what is not working for patients.
She said that in 2019 it was pointed out that it was unfair that others would be denied as they did not have private health insurance or were not covered by access to the drugs, and that this could become the same for treatment. She said that there are long delays in getting patients access to drugs due to the reinbursement system.
"We want accelerated action in this area because cancer drugs give cancer patients hope, better quality of life and better cancer survival."
She added that the drugs are made available to all in other EU countries and it should be the same in Ireland as Ireland also has one of the slowest treatment records in Europe.
She added that earlier diagnosis leads to better outcomes and better treatment, which is now better in the private sector, but there are calls to standardise under Sláintecare across public and private but according to the Irish Cancer Society, this was not moving fast enough even with incredible pressure on the system.
"We are hoping a new direction can be taken by Government so that everybody can be guaranteed access to tests and treatments within the timeframes recommended."
She also pointed out that cover for private patients can differ for those on gold plated cover versus those on different cover coming from the same provider.