Rare Disease Patient ‘Fighting for Survival’ as HSE Stalls Drug Access 23 Months

For healthcare policymakers and clinicians, Emily Felix’s story exposes the gap between regulatory approval and actual patient access in Ireland’s health system. The 23-month delay in making a reimbursement decision on an orphan drug raises urgent questions about whether the current HTA process adequately weighs the rapid functional loss of progressive rare diseases against budget impact considerations.

In a landmark judicial review challenge, Emily Felix, a 28-year-old woman with Friedreich's ataxia (FA), has sued Ireland's Health Service Executive (HSE) and the Minister for Health over an alleged 23-month delay in deciding on reimbursement for Biogen's omaveloxolone (Skyclarys). The drug is not a cure but is the first treatment capable of slowing progression of this rare, inherited neuromuscular disease. Felix, who relies entirely on a wheelchair and requires assistance in all daily activities, filed the case asserting her “fight for survival” — a stark illustration of the human cost behind pharmacoeconomic bureaucracy.

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For healthcare policymakers and clinicians, Emily Felix’s story exposes the gap between regulatory approval and actual patient access in Ireland’s health system.

The HSE’s reimbursement pathway requires a formal application, a health technology assessment by the National Centre for Pharmacoeconomics (NCPE), subsequent HSE deliberations, and ministerial approval. Biogen submitted its pricing and reimbursement application in August 2024, yet a final decision remains pending, even as the drug is already funded and available in 12 other EU member states following European Commission market authorisation in February 2024. The NCPE completed its evaluation in December 2025, suggesting that potential affordability or cost-effectiveness concerns are now the primary bottleneck.

The case raises profound questions about Ireland’s obligations under the European Union’s Cross-Border Healthcare Directive and the constitutional right to life and bodily integrity. Delayed access to a proven therapy for a progressive condition means measurable neurological deterioration that could have been mitigated. From a legal standpoint, the challenge targets the HSE’s failure to make a timely decision — a direct judicial review of administrative inaction, rather than a dispute over clinical efficacy or safety. Judge Cian Ferriter’s decision to grant leave for the review on July 28, 2026, signals that the court considers the matter arguable and warrants full hearing.

For the pharma industry, the case underscores the European paradox of drug access: centralised EMA approval does not guarantee patient access, as pricing and reimbursement remain fiercely national competencies. Ireland, with its relatively small market, often sees delays or complete denials for ultra-orphan drugs due to blunt incremental cost-effectiveness ratio thresholds. Biogen’s Skyclarys, priced likely in the six-figure euro range, faces a perennial tension between sustainability of public health spending and the acute needs of a tiny patient population.