Patients on low incomes missing out on vital cancer treatment, warns leading oncologist

Consultant medical oncologist Gráinne O’Kane: 'What do I do? Do I tell the patient who doesn’t have private health insurance, who is low income, who has five kids at home, that there is a drug you could potentially access but it costs this amount?' Picture: stjames.ie

A leading oncologist has warned that patients on low incomes are missing out on vital cancer care as more and more new life-saving drugs are only available to those who can afford to pay.

Gráinne O’Kane’s stark warning came almost a year after Michael McCarthy cautioned that a two-tier system, based on ability to pay and similar to the US model, was emerging in Ireland.

Prof O’Kane, speaking at the Irish Pharmaceutical Healthcare Association (IPHA) conference, became visibly distressed describing tough conversations with patients.

“We’re in this position now where I’m sitting and asking that question — and I hate it — ‘do you have private health insurance?’" she said. 

"What do I do? Do I tell the patient who doesn’t have private health insurance, who is low income, who has five kids at home, that there is a drug you could potentially access but it costs this amount?

“We just have to think about what we want to do here, and what identity we want to have in Ireland given our position in Europe.”

An oncologist with St Vincent’s University Hospital, Prof O’Kane also called out delays in approving effective treatments.

The European Medicines Agency approves treatments broadly for the EU. Each country then makes its own assessment of whether to provide the drugs for patients. HSE consultants now see a significant time-lag between how quickly Irish public health authorities act to approve new drugs when compared to private insurers.

“I think we need to take a whole new approach to how we’re assessing our drugs,” Prof O’Kane said.

We need a transparent approach, we need a collaborative approach, and I think if we can have a system where we are working closely with Europe, this is the only way to move forward for our patients — so there is no-one disadvantaged and there are no disparities across the island.

Cancer patient Bernard Mahon described how he dipped into money set aside for his son’s wedding to fund “very expensive” life-saving treatment. His private health insurer initially refused to cover a game-changing drug, so he paid around €8,000 for the initial round of treatment, saying: “You don’t have the time to wait”.

Former HSE chief executive Tony O’Brien also addressed the conference, saying: “It is just appalling to hear again, as we did last year, of the dilemma faced by oncologists who are having to ask that question. 

"It’s the old ‘are you VHI-positive?’ question. It should not be part of our cancer control framework at all.”

Health minister Jennifer Carroll MacNeill said 34 staff have been hired to enhance the HSE’s medicines pricing and reimbursement process. 

She welcomed approved funding for almost 200 new medicines and said a new framework agreement will be negotiated between the State and pharma companies. She told members of the IPHA:

I really encourage you to give thought on how we can have even more creative solutions to ensure access, affordability, and availability of medicines for patients.

The association’s president, Shane Ryan, said: “One of the most pressing issues in 2025 is the disparity in patient access to medicine.”

Their analysis showed 86% of medicines, reimbursed over three years, took longer than the 180 days allowed under the Health Act for approval.

The association estimated that staying under the 180-day target could mean accessing “new medicines within a year rather than, on average, nearly two years”.

However, the HSE said the State is obliged to robustly assess new medicines to ensure they deliver improved value for money across patientcare.

During 2023, the proposed costs for new medicines came to more than €400m over five years. After negotiation, this figure was reduced to “€200m over five years”, the HSE said.