Tony O’Brien

At a recent conference, a senior medical oncologist from one of the State’s largest hospitals told the audience that — for the first time in his career — he was having to ask his patients if they had private insurance. This doctor does not practise privately, so insurance status has never been a big concern for him.

He explained how over the last nine months or so it had become clear to him that he can no longer provide all his patients with a chance of the best possible outcome following cancer diagnosis because a range of new cutting-edge cancer therapies are not available to public patients — but are being provided through private hospitals paid for by the private health insurers.

Last June, for example, Laya Healthcare wrote to healthcare providers to explain it now intended to “cover innovative cancer drugs much earlier, as soon as they have been approved for use at European Medicines Agency-level”.

Laya explained it was doing this because “achieving best outcomes for our members is at the heart of our decisions when it comes to covering cancer treatments and services”.

This health insurer is not alone in this new approach and, in common with all the insurers, access to these medicines is subject to clinical criteria and a pre-approval process. But the bottom line is that privately insured patients who meet the criteria are getting access to these new treatments hundreds of days or even years before their public patient counterparts. This once again shines a light on the comparatively slow new drugs reimbursement process in Ireland.

These are new medicines like Sacituzumab, which is used in the treatment of triple negative breast cancer and for which there is robust clinical data. Other drugs involved include Cemiplimab, Dostarlimab and