Immunologist calls for universal access to drug that prolonged Vicky Phelan's life

Vicky Phelan credited Pembrolizumab with having given her three more years than she would have expected if she had just stayed on chemotherapy. Picture: Naomi Gaffey

One of Ireland’s leading immunologists has called for universal access to a drug that prolonged the life of cancer campaigner Vicky Phelan.

Professor Bernard Mahon, who has late stage stomach cancer, was initially refused access to treatment with Pembrolizumab by his private health insurer.

But, after he and his children took to social media and ran a campaign of awareness about it and the receipt of further information insurance officials had asked for, Laya Healthcare changed its mind.

The company has now agreed to fund treatment “on humanitarian grounds” after a review of its initial refusal in October.

Also known as Pembro, the drug - which stimulates the body's immune system to fight cancer cells - is licensed by the European Medicines Agency (EMA) mainly for advanced cancers.

Ms Phelan credited it with having given her three more years than she would have expected if she had just stayed on chemotherapy.

The cancer campaigner, who died in November 2022, successfully fought to have the 221 women affected by the Cervical Screening Scandal given access to it free of charge.

Also known as Pembro, the drug — which stimulates the body's immune system to fight cancer cells — is licensed by the European Medicines Agency (EMA) mainly for advanced cancers.

The HSE eventually agreed to extend the treatment - which costs up to €8,500 every three weeks - to all cervical cancer patients.

“That Laya has agreed to fund it for a limited amount of time is wonderful news,” said Professor Mahon, who is the Professor of Immunology and Cell Biology at Maynooth University.

“I am so very, very grateful to Laya for having changed their mind. I really hope this leads to more men and women getting treatment with Pembro. There should be equity of access regardless of the insurer.

“Access to this drug treatment should not just be for those fortunate enough to be able to pay for private health insurance. But it should be available on the national health service for everybody who needs it.

“There is something very wrong about people with money being able to afford to extend their lives with a drug treatment that is still not freely available to everybody with late stage, inoperable cancer.”

The 62-year-old, whose three children and wife have been Laya customers for more than 20 years, said his case should serve as a warning call to anybody with private health cover.

“But despite my consultant recommending treatment with Pembro, Laya initially said it would not reimburse me for the treatment," said Professor Mahon, who was diagnosed with cancer in August.

“People need to ask their insurers on what grounds their provider will not pay for care despite that care being the recommended course of action by the consultant treating them.”

Health insurance firms

In its November 8 letter to Professor Mahon’s consultant Professor David Gallagher, Laya stated: “In consideration of the specific clinical circumstances of (Professor Mahon) and on humanitarian grounds, we have decided to grant the benefit on an exceptional case basis.”

A Laya spokesperson later told the Irish Examiner: "Following a clinical review, we recently declined coverage for Pembrolizumab for certain gastric cancer indications due to limitations on the clinical evidence submitted by the referring Consultant.

"We informed the consultant of this decision and they submitted an appeal supported by additional clinical evidence.

"On receipt of the additional information provided, our clinical team, supported by our medical advisory panel, re-reviewed the submitted evidence.

"Without this additional clinical information, we would not have been able to grant approval."

A spokesperson for Vhi said: “Vhi first reimbursed Pembrolizumab in September 2016. The decision as to what treatment is given to a patient rests with the treating consultant in consultation with the patient.”

A spokesperson for Level Health said: “Level Health has an agreed drug schedule with each hospital providing cancer services and processes agreed with each hospital for the approval of drugs listed or not listed on that schedule.

“Pembrolizumab is included on the drug schedule and is subject to pre-approval.”

An Irish Life spokesperson said: “Irish Life Health covers the costs of the majority of medicines prescribed by a consultant, administered in a hospital and used for cancer treatment.

“We do cover Pembrolizumab for the treatment of cancers that have been approved by the European Medicines Agency.”