Erin McGreehan (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I welcome the Minister of State to the House. I acknowledge that my colleague, Minister for Health, Deputy Donnelly, has apologised that he could not be here, nor was a Minister of State in the Department available to discuss this issue. I ask that the Minister make a statement on the access to cancer drugs and treatment for private and public patients. I want to shine a light on important issues that require immediate attention. It is a hugely concerning matter that within our healthcare system, there exists a glaring disparity in access to cancer drugs and treatments. This inequity has become increasingly pronounced as private health insurance holders gain immediate access to lifesaving treatments, while public patients are left waiting in uncertainty. The stark reality is that patients with private health insurance are often able to bypass waiting lists, expedite their treatment process and secure access to vital cancer drugs. Meanwhile, public patients, who do not have the same financial means, are left to navigate through prolonged waiting periods and face uncertainties about their health and well-being.

I read a report in the Irish Examiner about oncologists in Galway such as Dr. Michael McCarthy, who stated that up to 2023, the only difference between public and private hospitals was the speed of access to certain procedures, but not access to treatments. That is access to vital lifesaving treatments, and the potential of the difference between life and death. Ireland had a proud record in treating cancer, but this is a retrograde step. We all understand the issue, because it is personal to many of us. Cancer is the biggest killer in Ireland. It accounts for approximately 30% of deaths every year. An estimated 42,000 people in Ireland get cancer every year and more than 9,620 people die every year from cancer.

Let us imagine a situation where we have preventable deaths from cancer occurring because a person does not have health insurance. We cannot stand over it and we cannot accept this. Ireland is at the bottom of the latest European table when it comes to access to new cancer medicines, ranking 29th among the 36 European states regarding the median time for reimbursement of oncology drugs. This clearly demonstrates the need for speedier reimbursement timeframes for cancer medicines. Based on the website for the National Centre for Pharmacoeconomics, it can be estimated that 24 European Medecines Agency, EMA, approved IV oncology products across 33 indications sought public reimbursement between 2021 and 2023 but had not been approved by the end of 2023. My plea is for an early access pathway for new life-changing cancer medicines that is introduced with haste.

Ireland needs to pool bids for new drugs more often with other countries. We have previous examples of this. Data shows that 40% of new drugs are not even offered to the HSE by pharma companies, due to our small population. Too many patients are missing out on medicines that are routinely available in other countries, including Northern Ireland. Currently, the reimbursement system and lengthy approval timelines do not put patients at the centre of the process. I accept and appreciate that the Minister is working to improve the reimbursement system but the improvements are not being seen quickly enough. When we see politicians week in and week out in these Houses pleading to get access to certain drugs and treatments for a constituent, it is glaringly obvious that the system is broken.

We need to look at what other countries are doing, for example, France, and see what we can use here. The Haute Autorité de Santé, HAS, system in France allows innovative medicines in areas of high unmet need to be reimbursed rapidly, within three months of EMA approval by temporary fast-track pathway while the full HDA normal assessment continues

Malcolm Noonan (Carlow-Kilkenny, Green Party)
Link to this: Individually | In context | Oireachtas source

I thank the Senator for raising this important commencement matter. As she stated, I am taking this question on behalf of my colleague, Minister for Health. The Government is committed to the ongoing implementation of the national cancer strategy and the delivery of quality care for cancer patients. The Government also acknowledges the importance of access to medicines and has made considerable investments in new medicines in recent years.

Last year, a record of more than €3 billion in public funding was spent on medicines for patients in Ireland. This represents almost €1 of every €8 spent by the State on healthcare. This is in the context of overall total allocation of the health service for 2024 of €22.5 billion. Budgets 2021, 2022 and 2023 included dedicated funding for new medicines of €98 million. This has enabled the HSE to approve reimbursement for 148 medicines or licence extensions, including 61 for treating cancer and 39 for treating rare diseases. In addition, the Minister secured funding in budget 2024 for an additional 34 staff across the pricing and reimbursement process. These measures will enable the assessment of a greater number of medicines at a quicker pace and ensure that patients can easily remain informed on progress.

I am pleased to confirm that hiring of these additional staff has now commenced, however, expenditure has grown rapidly, and we must ensure that sustainability of medicines expenditure. We must strive to maximise the available investment and provide as many people as possible with access to medicines that they need. In this context, there are policy and operational options being pursued and will be intensified including, for example, maximising the use of generic and bio-similiar medicines across community and hospital settings. The Senator also made positive suggestions in her opening commentary. Budget 2024 made €30 million available for new drugs.Of this sum, €20 million has been invested directly by the Government and €10 million has come from efficiencies to be identified by the HSE. This funding has enabled the HSE to approve reimbursement for 13 new medicines so far in 2024.

As regards private health insurance, this is a voluntary, community-rated market, which is underpinned by certain principles, including minimum benefit, that are set out in law. The Health Insurance Act 1994 (Minimum Benefit) Regulations 1996 require insurers to offer a minimum level of cover to every insured person. The Minister does not have a role in the commercial decision-making of any private health insurer.

Private health insurance companies operate as commercial entities in a competitive private health insurance market. Beyond prescribing under the regulations the minimum level of coverage that health insurers must provide, the State is not in a position to direct any insurer to provide cover for any particular procedure, service or medicine, or direct how that cover is to be provided. Insurers are free to provide treatments beyond what is provided for in these regulations or what is approved for use in public hospitals.

I stress that Ireland is absolutely open for business and welcomes pricing and reimbursement applications from all marketing authorisation holders for all newly approved medicines. I note the points the Senator made about Ireland’s market being small. The Minister is committed to working to improve the reimbursement system. The Senator’s point about learning from other jurisdictions is important too.

Erin McGreehan (Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I reiterate my plea. I do not disagree with anything the Minister of State said but we must have an early-access pathway. We must pool bids with other countries and look at what they are doing. We must also look at ourselves as a State, country and Government. There is a moral and ethical issue here. Will we be able to stand over a situation where people with money can get treatment while people who do not have money cannot get treatment? I do not think the Government or State wants to stand over some poor family saying they could not afford health insurance and their loved one died whereas Johnny down the road could afford it and he is living, thriving and surviving and benefiting the State by being a healthy cancer survivor. That is a larger issue that the Government must take on. I accept that private health insurers have their own market but we have an obligation to the people of this island.

Malcolm Noonan (Carlow-Kilkenny, Green Party)
Link to this: Individually | In context | Oireachtas source

I agree wholeheartedly with the Senator on this. I assure her that the Minister for Health appreciates the importance of ensuring patients in Ireland have prompt and equitable access to the latest drugs. This is why the State has made considerable investments in new medicines in recent years. Over €3 billion of public funding was spent on medicines for patients in Ireland last year. Since 2021, we have provided the budget to allow the HSE to approve reimbursement of 148 medicines or licence extensions, including 61 for cancer. Budget 2024 will make €30 million available for new drugs. This has enabled the HSE to approve reimbursement for 13 new medicines so far this year.

As I noted, in Ireland we have a voluntary community-rated health insurance market and the Government, including the Minister for Health, does not have any direct role in the day-to-day commercial decisions of the health insurers. Again, I note on behalf of the Minister the points the Senator made about early-access pathways. Outcomes are improving for cancer care in Ireland. However, in the spirit of Sláintecare, it should not be a two-tier system. It should be equitable for everybody and not based on ability to pay.