Enhancing access to oral cancer medicines in Lebanon: exploring innovative benefit package designs in private insurance

Cancer treatment is costly and burdens patients and healthcare systems. In Lebanon, the healthcare system is already strained by the 2019 economic crisis, the COVID-19 pandemic and the 2020 Beirut port explosion. While both the Ministry of Public Health (MoPH) and private insurance schemes cover mainly inpatient cancer treatments, outpatient medications are excluded. Hence, cancer patients rely on out-of-pocket payments, unnecessary hospitalization, or unverified alternative treatments, compromising treatment sustainability and cancer management. To explore sustainable partnership models between pharmaceutical companies and private insurance companies, with the engagement of the public sector, to improve access to outpatient oral cancer medications in Lebanon. This paper consolidates findings from: (1) a narrative review on cancer medication coverage focusing on global innovative insurance models; (2) interviews conducted with Key Opinion Leaders (KOLs) in the insurance and healthcare sectors assessing the current gaps in cancer care coverage and exploring potential solutions; and (3) a roundtable discussion, held at the Association Des Compagnies d’Assurance Au Liban (ACAL) premises, with stakeholders gathering feedback on strategies to enhance access to cancer medicines in Lebanon. Interviews revealed challenges in Lebanon’s private insurance sector, particularly the lack of outpatient oncology medication coverage. KOLs proposed solutions including long-term partnerships with pharmaceutical companies, pooled risk funds, and add-on insurance riders. Public-private collaborations, including engagement with the MoPH and the National Social Security Fund, are essential for expanding coverage. The roundtable discussion highlighted the need for a cost-sharing partnership model and a phased approach for testing program effectiveness. Stakeholders also proposed establishing an independent pooled oncology collateral fund for non-covered outpatient care, including medications, based on global coverage models and an actuarial analysis to support the financial frame of such a program. A stand-alone coverage program, managed by ACAL, was proposed to cover oncology outpatient oral medications, and potentially other oncology-related services. This model aims to provide affordable cancer treatment and ensure sustainable cost management. Lack of outpatient coverage and Lebanon’s strained healthcare system compromise sustainable cancer treatment. Partnerships between private insurance and pharmaceutical groups can improve access to oral oncology treatment. Public-private collaboration is key for expanding cancer care and reducing patient burden. A stand-alone National Cancer Fund managed by ACAL may offer affordable long-term outpatient coverage.