Public/private cancer drugs row: Cancer drugs for 'several new clinical indications' being covered by VHI

Cancer drugs for “several new clinical indications” are now being covered by the VHI, the private health insurer has confirmed.

The drugs are currently available to public patients, but not for all the clinical indications listed by the private health insurance company.

The VHI recently wrote to consultants about the drugs, pointing out that the clinical indications listed are in line with international best practice and subject to prior approval.

“VHI is committed to ensuring that our members can avail of new and proven innovative treatments in a timely manner,” the company stated.

However, Dr Janice Walshe, a consultant oncologist, said it is “very frustrating” that she can not provide the same level of care to both public and private patients.

Dr Walshe, who was speaking on RTÉ radio, pointed out that the only benefactors of the VHI programme would be patients in private hospitals - it will not be available to VHI patients undergoing cancer treatment in a public hospital.

The clinical director of the National Centre for Pharmacoeconomics, Prof Michael Barry, said the drugs that were given the go-ahead by the VHI are currently going through the approval process. He added that funding the drugs offered by the VHI, at the current price, would cost the HSE €100m over five years.

Prof Barry said making some cancer drugs available to some private patients raises an “equity issue”.

There is a system in place and, whatever people feel about it, it does ensure equity.

He said the centre has concluded its assessment of the breast cancer drug, Perjeta, in January.

“We concluded that, yes, there was value in the drug but we felt that the price was too high at about €61,000 per patient per year,” he said.

They suggested to the HSE that negotiations would be required and those negotiations are continuing.

The HSE said it has already approved 23 new drugs for reimbursement to date this year, including a number of new cancer drugs and has more applications scheduled for consideration during the year.

“There is a very clear process for assessing applications for the public reimbursement of medicines, and this is being followed in respect of the drugs and the conditions now being referred to,” the health authority stated.

The usual pattern up to now is for the health insurers to follow the public service reimbursement process. One insurer appears now to have decided to proceed in advance of the other insurers, including the State, in relation to these particular conditions.

Laya Healthcare said achieving the best patient outcome for their members is at the heart of their decisions on covering cancer treatments and services.

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