The insurability of innovative pharmaceutical cancer technologies

Abstract

The scientific literature, including several papers published in the IJHPR, has raised the issue of the spiraling cost of cancer treatment, including that of cancer drugs and other technologies such as gene and cell therapies. In this perspective, we review three criteria for insurability and show that they may not be met.First, the uncertain trends in the cost of innovative pharmaceutical and other cancer technologies make the maximum possible loss per event very difficult to predict and to manage in terms of insurer solvency. Second, the uncertainty of the price, the period that a drug or other cancer care technology will be administered and the number of individuals that will need the technology makes it difficult to predict future insurance premiums and whether they will be affordable to the target population. Third, public coverage needs to be consistent with societal values. However, pressure to limit public coverage will gradually increase as the possibilities of innovative pharmaceutical cancer technologies expand, thus transferring the burden onto commercial insurance. This is a phenomenon that is virtually impossible to predict accurately, but which will certainly undermine the status of health as a social good.We conclude that the financial risk arising from the use of innovative pharmaceutical cancer technologies fails to meet the aforementioned criteria, thus raising questions as to the sustainability of commercial insurance for cancer treatment and suggesting the need for the state to take greater responsibility for covering this financial risk in the future.

Patients’ and oncologists’ perceptions towards the discussion on high-cost innovative cancer therapies: findings from a qualitative study

“…Two interview guides were formulated based on the literature6 7 11 12 and input from clinical cancer experts. The interview guides comprised similar non-directive and open-ended questions about perceptions, concerns, emotions and experiences with unfunded high-cost cancer therapies.…”

“…The voluntary health insurance market share in Israel covers 84% of the population. 12 In the present study, we examined the perceptions of oncologists and the perceptions of patients and family members when it comes to innovative cancer treatments. Aspects we explored included public versus private financing, therapist-patient-family discourse, modes of decision making and how they are reflected in health policy and inequalities.…”

“…Furthermore, commercial insurance companies offer various insurance options and health services tailored to individuals, including pharmaceuticals. The voluntary health insurance market share in Israel covers 84% of the population 12…”