A hospital consultant says he is having to offer public cancer patients in Ireland a treatment he knows is second best to one available through the private system.
Michael McCarthy, consultant medical oncologist at University Hospital Galway, said inequity in access to cutting-edge medicines had come about only in the past year.
Private health insurers are agreeing to fund medicines for Irish customers once they had been licensed by the European regulator, the European Medicines Agency (EMA), but this is before a sometimes years-long process to make the same treatments available more generally.
His comments at the Irish Pharmaceutical Healthcare Association (Ipha) annual conference of medical drug developers came as Minister for Health Stephen Donnelly said he was funding 34 new staff to try to speed up the approvals process for new medicines.
“Whether someone had insurance or not never crossed my mind [until recently],” said Mr McCarthy who works only in the public health system.
“I would never ask a patient whether they have insurance or not previously. But now, given the disparity in access, it is one of the first questions I ask an increasing cohort of my patients where now there is a EMA-licensed high cost treatment available and I know if they have insurance, they can get it in a private hospital.
“If I have a patient who does not have insurance, in an increasing number of settings for an increasing number of cancer types, I know that the only thing I can offer them is the second best kind of cancer treatment. It is frustrating for me personally and it is frustrating for patients,” he said.
Roughly half of the Irish population has no form of private health insurance.
Asked whether that meant it was now the case that a patient had a better chance of a positive outcome as an insured person going to a private hospital, he said: “Yes, that is the case and that is a new situation that I have never witnessed working in the HSE previously.”
He said treating a public patient with a course of cytotoxic chemotherapy might cost hundreds of euro compared to hundreds of thousands of euro for the treatments available in the private healthcare system.
Speaking on the same panel at the conference, Amgen country head Caitriona Duggan said drug manufacturers did not want a situation to develop where “inequity of access was one of the core pillars within the national Sláintecare reform programme”.
“It is not in our interest to spend billions developing medicines and then we are not able to submit them through the process,” she said.
Ms Duggan said just over a quarter of medicines developed by Ipha members were never submitted to the Irish system for approval “and we need to figure a solution around that”.
Earlier, Mr Donnelly told the conference he was allocating funding in the budget this year for 34 additional full-time posts in agencies dealing with drug reimbursement in line with a recommendation of a working group looking at a report by Mazars published last year into the Irish drug approvals process.
“It will have a direct effect on the speed at which medicines progress through to a reimbursement decision,” he said. It will also allow for more applications by new medicines to be considered.
Mr Donnelly said that €3.2 billion – €1 in every €8 spent in the Irish health system – was spent on medicines. While no provision was made in last year’s budget for new medicines, the Minister said he had found €30 million to cover the cost of new approvals this year, including €10 million of savings from elsewhere in the HSE budget.
He said the State had approved 36 new medicines or new indications for existing medicines last year.
Speaking later, Sinn Féin health spokesman David Cullinane said it was “just a real source of frustration that a country that is a leader in producing the drugs with all of that innovation ends up not ranking much higher than we should be in relation to access” compared with other countries across Europe.
New staff would obviously help, he said, adding that the Minister’s commitment was clearly “a recognition of the problems” in the system. But he said the “biggest issue for me is the funding side of it”. He promised that if he were to become health minister after an election he would introduce a system of multiannual funding for new medicines.
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