Ongoing tensions between access and affordability of cancer medications

In late 2020, the Irish Society of Medical Oncology (ISMO) wrote to the National Cancer Control Programme (NCCP) about the lack of funding for new cancer medications.

As the Medical Independent (MI) reported, ISMO considered disengaging from the NCCP if the situation did not improve.

When questioned at the time, the HSE admitted there was a decrease in the number of drugs approved by the Executive in the early part of the year due to funding issues.

However, the landscape changed with the 2021 Budget, where €50 million was earmarked for new medicines.

The Irish Pharmaceutical Healthcare Association described this increase in support as “a game-changer”.

In response to a recent parliamentary question (PQ) from Fine Gael Deputy Barry Ward, the Minister for Health Jennifer Carroll McNeill pointed out that Budgets 2021 to 2024 allocated an additional €128 million for new medicines. This has facilitated the introduction of 194 new medicines, including 74 for cancer.

Budget 2025 allocated €30 million for new drugs to come from efficiencies to be identified by the HSE. Of this, €10 million was specifically allocated to cancer therapies.

In her PQ response, the Minister also noted that an additional 34 staff were hired across the system last year. This development followed the recommendations of a review of the pricing and reimbursement system published in 2023.

“This is a significant investment by the State and will have a positive impact on the speed of assessment of new medicine applications that are received,” she said.

Another key recommendation was the implementation of a pricing and reimbursement medicines tracker to be developed by the HSE. This tracker has now been launched with the initial iteration available since December 2024. 

“This will provide transparency and certainty to patients and industry on the current status of the pricing and reimbursement applications of a drug,” according to the Minister.

Despite this progress, issues still remain.

In its recent pre-Budget submission, the Irish Cancer Society (ICS) pointed out that access to new medicines remains “significantly slower and more limited” in Ireland than in other countries.

In its recent pre- Budget submission, the Irish Cancer Society pointed out access to new medicines remains ‘significantly slower and more limited’ in Ireland than in other countries

“As a result, patients are being denied medicines that can significantly improve and save lives,” according to the ICS.

A feature in this issue of MI on the assessment of the prostate cancer medication Lu-PSMA-617 (Pluvicto) highlights some of the tensions with the reimbursement process.

A large number of consultants working in oncology were unhappy with the HSE drugs group’s decision not to recommend reimbursement.

The decision was based on limitations of the VISION trial that assessed the drug, as well as cost considerations.

However, the letter sent to the HSE CEO from the specialists pointed out that Lu-PSMA-617 is an important last line of therapy for many men with advanced metastatic prostate cancer who have progressed through hormonal therapy and chemotherapy without other therapeutic options.

The letter highlighted that Lu-PSMA-617 is already reimbursed by public health systems in several European countries and that a failure to fund the therapy would deepen health inequalities.

Ultimately, the HSE senior management team decided to accept the drug group’s recommendation.

Perhaps it is inevitable there will be friction between clinicians and management on the availability of
new treatments.

But more can be done to ensure these tensions are lessened.

The State is due to negotiate successor agreements to the framework agreements on the supply and pricing of medicines with the pharmaceutical industry.

The outcome of these talks will be crucial in shaping how quickly and equitably patients in Ireland can access new therapies, including those for cancer, in the years ahead.