Private medical insurance  has been paying for the wonder drug Herceptin which has been used by several breast cancer patients after the NHS refused to give them Herceptin.

Since last year BUPA has provided Herceptin to around one hundred women who were identified as being in the initial stages of the lethal HER-2 positive type of breast cancer.  At the same time Standard Life has apparently paid for the same drug in thirty cases in the early stages of breast cancer. And since last year Norwich Union has also provided for Herceptin in first stage cases.

Lately two women with early stage breast cancer went to the High Court in an attempt to get Herceptin for treatment through their health trusts. The predicament is that Herceptin is so expensive. It costs in excess of twenty thousand  pounds for a year on Herceptin and some cash-strapped have plainly refused to fund the drug, even though Patricia Hewitt the the Secretary of Health, has commanded them to make it obtainable if doctors believe it will help.

The medicine is used after surgery, radiotherapy and chemotherapy to avert  the reoccurrence of HER-2 positive. In subsequent years the drug has been prescribed by the NHS for women with late-stage cancer. But , Roche, its manufacturer has just recently applied to the National Institute of Health and Clinical Excellence for its approval to use the drug in first stage cases.

Mrs P.T from Manchester was 6 months’ pregnant when she first noticed she had a lump in her left breast. ‘My Doctor first thought the lump was a blocked milk duct’, she said. But after she had had the baby it didn’t go away,so during a routine check-up she mentioned it to the Doctor. She was then referred to a consultant.

The specialist diagnosed her with HER-2 positive breast cancer, but she lives in London  a vicinity where Herceptin was not offered by the local health trust. Luckily for her she had medical insurance through BUPA which was prepared to pay for the treatment on her consultants recommendation.

’If I’d been told I couldn’t have it, I would have been devastated’ she said. At a time when you are in shock and struggling to get well, you don’t need another struggle for the best medicine to help you.’

Herceptin has been known to cause heart failure, so Bupa is carefulcautious to fund the drug only when the decision to use it has been made jointly between the patient and her oncologist. A representative from Bupa said: ‘Many drugs have possible side effects. We never make a decision to agree to any explicit drug without getting proof of its probable benefits. We believe we have now made a proper assessment.  And others have made the same decision – branches of the NHS have now determined to pay for Herceptin in the first stage of HER-2 positive breast cancer.’

But not all health insurance companies will cover the expenditure of Herceptin. Axa PPP says: ‘Our plans provide for the treatment of critical illnesses which are likely to respond quickly to medication. In the case of cancer, this can involve surgery, chemotherapy and radiotherapy. Our company does not pay for treatment that has not been proven as being effective. On this basis we do not fund for the use of Herceptin treatment of breast cancer that has not escalated (that is the cancer remains a primary disease). AXA is conscious of recent trials with Herceptin for treating primary breast cancer, but these facts have yet to be totally assessed by the National Institute for Health and Clinical Excellence so it has not been subject to full analysis.

Bupa suggests that women who want to ensure they are fully covered for the use of Herceptin should put to their health insurer the following five questions:

1. Will they cover you for secondary cancer (ie, if I get breast cancer and it then spreads to your lungs)?

2. Will the private health insurance cover you for every stage from diagnosis through to treatment?

3. What professional accreditation does the treatment need to make sure that you are diagnosed and taken care of?

4. Will the medical insurance cover you to use Herceptin for both the earlyfirst and late stages of cancer? If so, for how long?

5. At what point would the insurance company stop paying for cancer care

 

This article has been written for publication by Brokers Online. Brokers Online offers uk residents access to many different kinds of financial products including life insurance quotes and cheap loans.

Brokers Online aims to provide its clients with a huge resource of financial information including helpful articles and Frequestly Asked Questions. If you cannot find the answer to your question feel free to post a question on our weblog.

Australian General Interest Blog

Leave a Reply

You must be logged in to post a comment.