Health Insurance Irish Times "VHI has much better cover for new cancer drugs"

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valery

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From the article in todays Irish Times by Paul Cullen. According to Prof Ray McDermott, Oncologist, “Ireland is the second worst in Europe for access to new cancer drugs”.

The article also quotes Prof John Crown “people who are choosing what health insurance company to join or who are existing members of insurance companies need to be aware that there is a substantial difference in access to modern cancer treatments in favour of VHI compared to the other two companies”.

VHI generally reimburses a new drug within a month or two of it receiving EMA approval but this is not the case with Laya or Irish Life, who await the long drawn out HSE/NCPE approval which takes around 2 years.

Given that 1 in 2 people during their lifetime will receive a cancer diagnose, it may be prudent to consider Prof Crown’s advice.
 
As I am a Laya customer, I have just written a letter to their CEO and Board. I referred to the article above and advised them that it will be the deciding factor come renewal time.

I would encourage Laya and Irish Life customers to do the same.
 
Unfortunately this has been the case for many years now.

m.independent.ie

Three-tier divide opens up as Vhi covers its private patients' costs for top cancer drugs

A "three-tier" system of access to expensive cancer drugs has emerged after it was confirmed Vhi will only cover the medicines for its insured patients who are being treated in private hospitals.
m.independent.ie m.independent.ie

Laya and Irish Life are for profit companies and follow the HSE cost approval list as it's beneficial for their bottom line.

VHI is the odd one out in that it is still a non profit. They appear to use that to the greatest advantage for their customers in terms of offering new treatments much faster than the HSE cost approval system.

VHI offering this is placing commercial pressure on Laya and Irish Life to match them but only if their customers and/or the political/media system place enough pressure on them.
 
valery said:
VHI generally reimburses a new drug within a month or two of it receiving EMA approval but this is not the case with Laya or Irish Life, who await the long drawn out HSE/NCPE approval which takes around 2 years.
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Just so I understand this.

Someone has cancer and new drug comes out at €7k per month. The gist of the article is that VHI will pay this. Under what section of the policy is this being paid? Specifically, is it covered under "pharmacy" expenses or under some other section?

If "pharmacy" expenses, aren't the normal reimbursable limits very low?
If not covered under pharmacy expenses, then under what section of the health insurance policy?

What I'm trying to understand is the specific difference in contractual terms between VHI and the others?

[This does seem like a very serious issue - people think that they are covered for cancer when they are not really. There's a related point - perhaps for another thread - but interesting that in the article, the medics are quoted as focusing all the blame on the insurers. Isn't the reality that the core issue is the relative length of time taking to approve modern drugs in Ireland relative to other countries? For example, say LAYA and Irish Life acted like VHI, there would still be a very large cohort of people who wouldn't be receiving access to appropriate cancer treatment. Why focus blame on commercial entities when the state itself is failing its people?]
 
JimmyB99 said:
sn't the reality that the core issue is the relative length of time taking to approve modern drugs in Ireland relative to other countries?
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Agree totally with JimmyB99.
Per capita we are the second wealthiest nation in Europe and our access to new cancer drugs is the second worst in Europe beaten to the lowest position by Portugal.
 
Hi Valery

I didn't elaborate further on this aspect of our access to cancer as I didn't wish to derail the the thread from its initial focus.

What's mental is that the likes of LAYA won't pay for highly effective "wonder drugs" with proven efficacy but will still fund traditional cancer treatments which are still costly but miles less effective. And what's the big deal if LAYA/Irish Life cover patients after these drugs have been approved by the HSE? Is it not the case that once approved by the HSE, the cost of medication is covered under the Drugs Payment Scheme?

In essence, one major problem with cancer treatment in Ireland is, as follows:

1. If you have a terminal/serious diagnosis, to make life bearable, the hope that new treatment will become available in time, helps big time

2. This hope faces, at least 2 major hurdles, in Ireland

(a) Access to new medication - with proven efficacy in clinical trials - is not affordable for those without health insurance and those with the wrong health insurance provider

(b) Getting access to clinical trials in Ireland is extremely difficult


In my late sister's case, she could afford the €7k a month bill until 2 years later, the HSE decided that they would pay it. She would have died within those 2 years had she not have had the means to pay.

Then there was a very promising trial for her particular sub, sub condition which she couldn't get access to because accessing many clinical trials from Ireland is extremely difficult.
 
You misunderstand, Clubman

Effectively, once the HSE approves it, everyone has access to it. That's not the issue.

The issue, typically, is that the Irish State (via various agencies in the approval process) deems that next generation drugs are not value for money. Eventually, when pretty much every other European Country has approved such drugs in their primary tier healthcare, then (and only then!) will it become approved here. Truth is no one really gives a hoot about any of this until......you, or someone close to you, is impacted.

If you need these drugs when they first few years of their availability - you will not get them through LAYA or Irish Life and you will not get them via the public system.

Remember - if you need certain proven cancer drugs Laya will not look after you always. Dems the facts!
 
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The issue is that HSE/NCPE are taking up 2 years to approve drugs that have already received FDA, EMA approval. Next time you read about the very positive results from a new cancer drug, once it receives EMA approval, other European countries can fast track approval but not seemingly Ireland.
Second worst in Europe, it’s a disgrace!
 
valery said:
The issue is that HSE/NCPE are taking up 2 years to approve drugs that have already received FDA, EMA approval.
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Not the same thing, though. As the EMA indicate, it is not their remit to make a cost/benefit analysis of any new drug. They assess on the basis of clinical benefits, side effects and risks. It is the role of national authorities to make their own pharmacoeconomic assessment, based on local pricing, health budgets and health priorities.
 
Valery is not saying it's the same thing. I've no idea why you think that Valery may be equating the two.

Valery's central point, in this regard, is that Ireland is a laggard in approving new high tech drugs for reimbursement. There have been multiple articles about this. I agree fully with Valery.
 
JimmyB99 said:
You misunderstand, Clubman

Effectively, once the HSE approves it, everyone has access to it. That's not the issue.

The issue, typically, is that the Irish State (via various agencies in the approval process) deems that next generation drugs are not value for money. Eventually, when pretty much every other European Country has approved such drugs in their primary tier healthcare, then (and only then!) will it become approved here. Truth is no one really gives a hoot about any of this until......you, or someone close to you, is impacted.

If you need these drugs when they first few years of their availability - you will not get them through LAYA or Irish Life and you will not get them via the public system.

Remember - if you need proven cancer drugs Laya will not look after you always. Dems the facts!
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Or Look after you before you get ill as per advert
 
JimmyB99 said:
Truth is no one really gives a hoot about any of this until......you, or someone close to you, is impacted.
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Are we an uncaring society? Claire Byrne had a lady on her program this morning. Her meds are now "approved" by the NCPE. But they are not approved for reimbursement by the HSE. There are additional steps. Her life, literally, depends on gaining access to these drugs, she is a bright public servant, yet she can't even find out what the next steps are in approval process. What strikes me is that we've been here before - a neighbour of mine had a similar battle a couple of years back. He was able to quote me chapter and verse on multiple similar cases. As a society, we ask a private terminally ill person to go public to fight the system to gain access to the most effective medication. This is pretty pathetic. I think Jimmy is right, most of us don't really care enough.
 
Robzig said:
As a society, we ask a private terminally ill person to go public to fight the system to gain access to the most effective medication. This is pretty pathetic. I
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No country can afford to fund all new drugs treatments for all conditions, and none do. Germany is the most generous but even they only fund new drugs for one year before conducting a rigorous review in terms of value for money. It comes down to cost for qualify of life year added (or similar outcomes), and every country puts monetary value on this.
This naturally gets very emotive in situations of terminal illness where everyone wants hope and access to whatever might add more months to life. There are also regularly very emotive campaign in relation to chronic conditions. Pharmaceutical companies are only too happy to play on this, yet the astronomical prices they often put on some of these new treatments are a major impediment to payment approval.
One campaign some years ago related to a drug that cost close on €500,000 per person annually yet it showed only about 4 added qualify of life months to survival on average. Priceless for immediate family, of course. Yet it also has implications for other treatments, interventions and supports elsewhere. How many homecare packages? How may respite places to support unpaid family carers? How many places on rehabilitation places for stroke survivors? Etc.

I would be pleased to see a single tier equal access healthcare system for all based on insurance, such as in some European countries. But this also involves some ceiling being placed on expenditure on the most expensive high-tech procedures and niche drug treatments, particularly ones that show fairly marginal gains at a population level. By all means if some people wish to pay additional insurance premiums over and above that required for generic treatments then they can do so, but that also depends on the insurance companies and what they are prepared to cover.
 
Early Riser,

You believe, I think, that the article refers to niche treatments for rare cancers.

This is not the case. Breast cancer affects 1 in 9 Irish woman. Currently for some of these woman unless they are with VHI they have no access to the most modern treatments available in other E U countries and also Northern Ireland.
 
valery said:
You believe, I think, that the article refers to niche treatments for rare cancers
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It is not my belief that it relates to rare cancers - or just to cancer at all. Novel treatments should all be subject to pharmacoeconomic assessment. And dependent on the cost benefit ratio, not all will be approved. That is so everywhere. Drug companies can contribute a lot to this.
 
Early Riser said:
Novel treatments should all be subject to pharmacoeconomic assessment.
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Nobody is arguing against such an assessment, but rather the speed with which Ireland delivers that assessment. Second worst in Europe!

Incidentally your post above hasn’t changed my opinion, I liked it in error!
 
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