Health Insurance Expensive life extending drug, not available in Ireland

[elacsaplau]

I know someone who could benefit from a drug ("Drug A") which costs about €8,000 per month.

It is likely to extend his life by c. 9 months (normal range 6 to 12 months) over conventional treatments ("Drug B") which cost €4,000 per month.

Drug A is not approved in Ireland but is approved in France.

Legally, can the individual access this drug in France under EU regulations and how is this achieved?

 

[fizzy]

I've no idea about accessing treatment in other EU countries.
When you say Drug A is not approved in Ireland, do you mean it is licensed in Europe but not (yet?) approved by NCPE/HSE for reimbursement in Ireland?
Does the person have private health insurance & if so, has their doctor tried to get it covered through that?

 

[elacsaplau]

Thanks fizzy,

Apologies - my use of language was poor.

What I should have made clear is that the drug has been approved by the relevant regulatory authorities for use (the FDA and its EU equivalent, etc.).

By not being approved in Ireland, I meant that the National Centre for Pharmacoeconomics (NCPE) has decided that the drug does not represent sufficient value for money to be covered by the Irish public purse under various schemes (e.g. the drug payment scheme, available to medical card users, etc.).

Regarding private health insurance, my understanding is that there is typically relatively minor cover for prescription costs even in otherwise high level plans?

[I understand that it's a tricky balancing act for the NCPE. A separate debate - on a separate thread please! - is the value placed on life in different countries. In other words, the same data is available to all jurisdictions and in the case of this particular drug, the Canadian and French authorities believe that their citizens are "worth it" whereas the Irish and UK authorities don't! What price life?...…..tricky stuff!]

And so my question is that I believe one can access medical procedures abroad...….what about medication?!

 

[fizzy]

I know what you mean about no cover for prescriptions with private health insurance, but very expensive new drugs for cancer etc can be covered.
VHI can cover drugs not approved for public patients. So if that avenue has not already been explored by their medical team etc, I would certainly look into that.

 

[elacsaplau]

Thanks again fizzy,

I'll definitely look into this but am struggling to understand why would the VHI pay out on an uninsured benefit?

 

[fizzy]

I find it very confusing myself! I thought the table of benefits for health insurance was black & white, but it only deals with hospital stays & standard outpatient stuff. But they also pay for cancer treatment/drugs for example. VHI recently started covering drugs outside of those on the public HSE list on a case by case basis e.g. see https://www.irishtimes.com/news/hea...llow-vhi-s-decision-on-cancer-drugs-1.3861304

This may not be applicable in your friend's case & their medical team could best advise on what routes, if any, are available e.g. VHI, HSE compassionate access, clinical trials, self pay etc.

Hopefully others may have info on other options available to you. My own knowledge is very limited, but it's worth querying with the medics asap & then progressing as many options as possible.

I'm sorry your friend is in this position & wish them the best.

 

[noproblem]

As we don't know what the disease/sickness is that the patient is suffering from it's very difficult to say if it's value or not. For example, will the patient suffer before dying and if so would it not be better to get in touch with a Hospice and try and get relief in that way. As death in a relatively short time seems a certainty this is what I would do.

 

[elacsaplau]

With respect noproblem, you are answering a question which I did not pose. I had even gone further and specifically said.....

[I understand that it's a tricky balancing act for the NCPE. A separate debate - on a separate thread please! - is the value placed on life in different countries.....]