Lebanon’s private insurers weigh pooled fund to cover oral cancer medicines

A new study from Lebanon proposes a stand-alone national cancer coverage program, managed by the country’s private insurance association, to pay for outpatient oral cancer medicines that are currently excluded from most insurance benefit packages. The research, published in BMC Health Services Research, argues that without such a program, cancer patients in Lebanon will continue to depend on out-of-pocket payments, avoidable hospitalizations, or unverified alternative treatments.

The study was conducted against the backdrop of a healthcare system under severe strain. The authors note that Lebanon’s health sector has been burdened by the 2019 economic crisis, the COVID-19 pandemic, and the 2020 Beirut port explosion. Within this system, both the Ministry of Public Health (MoPH) and private insurance schemes concentrate their cancer coverage on inpatient treatment, while outpatient medications fall outside the benefit package. Cancer treatment is costly and burdens both patients and healthcare systems, and the exclusion of oral outpatient medicines leaves a gap that patients must fill themselves.

The research team, led by Shadi Saleh with colleagues including Rawad Chamandi, Paul Makhoul, and Omar Hussein, set out to explore sustainable partnership models between pharmaceutical companies and private insurance companies, with the public sector engaged, to improve access to outpatient oral cancer medications. The paper consolidates three strands of evidence: a narrative review of global innovative insurance models for cancer medication coverage; interviews with Key Opinion Leaders (KOLs) from the insurance and healthcare sectors; and a roundtable discussion held at the premises of the Association Des Compagnies d’Assurance Au Liban (ACAL), the Lebanese insurance industry association.

The interviews exposed a central weakness in Lebanon’s private insurance sector: the near-total absence of outpatient oncology medication coverage. According to the authors, this gap pushes patients toward out-of-pocket spending, unnecessary hospitalization, or unverified alternative treatments, compromising both the sustainability of treatment and the broader management of cancer in the country. The finding is a qualitative assessment of stakeholder perceptions rather than a measurement of patient outcomes, and the study does not report clinical results.

The KOLs interviewed in the study proposed several mechanisms to close the coverage gap. These included long-term partnerships between insurers and pharmaceutical companies, pooled risk funds that spread the cost of expensive therapies across payers, and add-on insurance riders that patients or employers could purchase to extend their existing policies. The researchers emphasize that public-private collaborations, including engagement with the MoPH and the National Social Security Fund, are essential for expanding coverage beyond what private insurers alone can deliver.

The roundtable discussion, which gathered stakeholder feedback on strategies to enhance access to cancer medicines, highlighted two further design elements. Participants called for a cost-sharing partnership model and a phased approach for testing the effectiveness of any new program before it is scaled. Stakeholders also proposed establishing an independent pooled oncology collateral fund to finance non-covered outpatient care, including medications. The financial frame of such a program would be grounded in global coverage models and supported by an actuarial analysis, according to the study.

The narrative review component of the paper served as the comparative backbone for these proposals. By examining innovative insurance models for cancer medication coverage worldwide, the authors identified design patterns that could be adapted to Lebanon’s mixed public-private system. The study frames the proposed Lebanese model as an adaptation of these global approaches rather than a replication, tailored to a market in which private insurers currently exclude outpatient oncology drugs and the public sector covers mainly inpatient care.

The study’s conclusion is a concrete proposal: a stand-alone coverage program, managed by ACAL, that would cover oncology outpatient oral medications and potentially other oncology-related services. The authors describe this model as a stand-alone National Cancer Fund that may offer affordable long-term outpatient coverage. The stated aims are to provide affordable cancer treatment and to ensure sustainable cost management, with the pooled fund structure intended to distribute financial risk across participating insurers rather than concentrating it on individual patients or single companies.

The researchers caution that the proposal is at the design stage. The findings come from stakeholder interviews, a literature review, and a roundtable consensus exercise; the study does not report implementation data, enrollment figures, or clinical outcomes for the proposed fund. The authors present the model as a starting point for pilot testing, consistent with the phased approach for testing program effectiveness that stakeholders endorsed during the roundtable. Whether the fund can be financed sustainably, and whether it improves access in practice, remain questions for future evaluation.

For Lebanon’s cancer patients, the significance of the study lies in what it identifies as the current default: reliance on out-of-pocket payments, unnecessary hospitalization, or unverified alternative treatments. The proposed ACAL-managed program, built on insurer-pharmaceutical partnerships, pooled risk, and public-private collaboration with the MoPH and the National Social Security Fund, is offered as a route to bring outpatient oral cancer medicines into a structured, affordable benefit package. The study’s highlights summarize its three key claims: that the lack of outpatient coverage and Lebanon’s strained healthcare system compromise sustainable cancer treatment; that partnerships between private insurance and pharmaceutical groups can improve access to oral oncology treatment; and that public-private collaboration is key for expanding cancer care and reducing patient burden.

Subject of Research: Health policy study on private insurance benefit package designs for outpatient oral cancer medicines in Lebanon

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

Article References: Saleh, S., Chamandi, R., Makhoul, P., & Hussein, O. (2026). Enhancing access to oral cancer medicines in Lebanon: exploring innovative benefit package designs in private insurance. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15558-z

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15558-z

Keywords: Lebanon, oral cancer medicines, private insurance, health policy, outpatient coverage, ACAL, pooled risk fund, public-private partnership, BMC Health Services Research, cancer care access, benefit package design, National Social Security Fund