In 2019, VHI became the pioneer in Irish health insurance to fund advanced cancer therapies once given the green light by the European Medicines Agency (EMA), a move celebrated by many oncologists for broadening treatment horizons in the private healthcare sphere. Despite this development, both Irish Life and Laya withheld from adopting this approach, choosing to fund the treatments only after they were incorporated into the public system for financing – a decision that created a distinguishable disparity in access to these often costly yet desirable cancer medicines between private and public patients.
The Health Service Executive (HSE) shoulders the burden of judgement calls regarding the reimbursement of new medicinal innovations. HSE approval is a protracted affair requiring an average of 20 to 30 steps depending on the medical solution, as detailed by the Irish Pharmaceutical Healthcare Association (IPHA). It typically takes around two years for an approval to transition from the EMA to the HSE, according to IPHA data.
Renowned oncologist Prof Michaela Higgins, currently presiding as the president of the Irish Society of Medical Oncology (ISMO), reveals how there used to be a significantly shorter gap between EMA and HSE approvals a decade prior. However, the influx of new and technologically advanced oncology medications, coupled with resourcing at the National Centre for Pharmoeconomics (NCPE), has led to these protracted waits.
During the approval process, the NCPE is tasked by the HSE to appraise the financial viability of a treatment based purely on cost. Thus, it follows that any NCPE recommendations involve prolonged and confidential price negotiations between the HSE and the respective drug manufacturer.
Recently, Robert Watt, the head of the Department of Health, disclosed the unsustainability of the escalating costs linked to new drugs, with medicine expenditure having risen from €1.3 billion in 2012 to €3.2 billion just last year.
Health Minister Stephen Donnelly recently proposed a plan focused on saving money across different healthcare areas. He aims to save up to €20 million on medicines over the course of this year. In February 2023, health department consultants confirmed the HSE method for financing medicines was abiding by legislative regulations and showing results that align with global standards, as per a report.
Post-report, a working group was instigated by Donnelly. The group’s objective is to deliberate over the suggestions detailed in the report. During the IPHA conference previously this year, Donnelly divulged that the final report by the working group was nearing its conclusion. Of the 17 suggestions, work would proceed on 13, including matters about transparency, involving patients, and adding a tracker for medicine reimbursement applications.