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.
Vhi members who are treated privately in public hospitals will not be eligible for the drugs.
It follows an announcement by Vhi that it will provide wider availability to the drug pembrolizumab for stage-three melanoma and pertuzumab for patients with stage-three breast cancer.
This was seen as exacerbating the two-tier public and private divide, because the HSE has so far not agreed to fund the drugs for these stages of cancer.
However, although Vhi has taken the step of moving ahead of the HSE, it emerged the drugs will only be available to patients treated in private hospitals which attract the most-costly cover plans.
A spokeswoman said: "Vhi has provided cover for pembrolizumab (Keytruda) since 2016 and Perjeta (pertuzumab) since 2014. We recently wrote to consultant oncologists advising them that we had approved several new clinical indications within our list of approved drugs, which are in line with international best practice and subject to prior approval.
"These drugs referred to are currently covered by the public system but not for all the clinical indications listed."
She said that "in public hospitals reimbursement is provided in accordance with the relevant statutory charges set by the Health Minister".
"These charges encompass all the services provided by the hospital to a customer while accommodated in a public hospital, including drugs."
St Vincent's Hospital oncologist John Crown said it was troubling that it would mean an inequity between public and private patients who are being treated for the same stage cancer.
The drugs are administered to patients through infusions which are given in day centres.
The HSE said there is a very clear process for assessing applications for the public reimbursement of medicines, and this is being followed in respect of the drugs and the conditions now being referred to. Drugs are assessed first by the National Centre for Pharmacoeconomics.
The HSE spokesman said the makers of the drugs MSD and Roche are to provide additional clinical and cost information as part of the examination of cost effectiveness.
Roche, which makes pertuzumab, said it was not yet contacted by Vhi but will happily engage. MSD did not respond.
Laya Healthcare, the other major insurer, said it welcomed the National Centre for Pharmacoeconomics review of both drugs and as ever when standards of care evolve and change, it will amend its treatment and procedures in consultation with its own medical advisory board.