People without health insurance increasingly unable to get cutting-edge cancer meds they need

Oncologist Michael McCarthy: '[I]f the EMA approves something today, then tomorrow the private patient will be able to access it — but for the public patient, it might take two years. Picture: Ray Ryan

People in Ireland without health insurance — about half of the population — are increasingly unable to access the latest cutting-edge cancer treatments that are available to private patients.

A gap has opened up in how quickly drugs are made available to private patients compared to public patients following a change in the way private health insurers cover cancer drugs that are newly approved by the European Medicines Agency (EMA).

In an echo of the system of healthcare in the US, Michael McCarthy, a medical oncologist at University Hospital Galway and secretary of the Irish Society of Medical Oncology, who works only in the public system, says he is now asking patients if they have private health insurance before deciding their treatment path.

“I’ve had to refer maybe four or five patients [with insurance] in the last few months to private consultants in private hospitals to get access to the latest drugs,” he said.

“And they are getting the access. It’s because all the main insurance companies, as of this time last year, publicly committed to making all oncology drugs available to private patients and private hospitals from the point when the EMA approves it.”

While new best-in-class drugs are available privately immediately, EMA approval is only the first step in getting such treatments through the public drug reimbursement process. The pharmaceutical companies must approach EU health services separately for assessment even after EMA approval.

“As things stand right now, if the EMA approves something today, then tomorrow the private patient will be able to access it — but for the public patient, it might take two years,” Dr McCarthy said.

Some 55% of adults in Ireland do not have health insurance, according to the latest figures.

Dr McCarthy said he has had patients in recent months without insurance, who are suitable for newer drugs, but who cannot access them.

“People are very different in how they react individually to situations: A lot of people just accept it,” he said. But I suspect that at some stage in the next year, there will be somebody like Vicky Phelan who will take it up very publicly.

“I’m a bit surprised that hasn’t happened so far, but I see it happening at some point.”

The Irish Cancer Society has already received queries from patients concerned about access to drugs. Director of advocacy Steve Dempsey said the situation is “ad hoc and arduous for patients, not to mention stressful”.

“Their anguish can then be further compounded by a lack of transparency and information surrounding the [public] reimbursement process,” he said.

“Many rely on the efforts of their physicians and private suppliers to close the gap — this is causing inequity within the treatment pathway.”

A review of the reimbursement process found that, while the HSE is “delivering results in keeping with international norms”, there is room for improvement.

A HSE spokeswoman said that a working group will “soon” submit a report to Health Minister Stephen Donnelly on how to improve the situation.

Between 2021 and 2023, the HSE approved 61 new cancer drugs.

• Irish Cancer Society Support Line: 1800 200 700 or [e-mail]