Private medical insurance has been paying for the wonder drug Herceptin which has been used to treat a number of breast cancer victims after the NHS declined to perscribe them Herceptin.
Since last year BUPA has provided Herceptin to about one hundred women who were identified as being in the beginning stages of the deadly HER-2 positive type of breast cancer. At the same time Standard Life has purportedly paid for the same drug in thirty cases in the early development of breast cancer. And since the previous year Norwich Union has also provided for Herceptin in initial stage cases.
Lately two women with initial stage breast cancer went to the High Court in an attempt to obtain Herceptin for treatment out of their health trusts. The trouble is that Herceptin is so expensive. It costs in excess of 20,000 pounds for a year on Herceptin and many impoverished trusts have simply declined to fund the drug, even though Patricia Hewitt the the Secretary of Health, has instructed them to make it accessible if doctors feel it will help.
The drug is used subsequent to surgery, chemotherapy and radiotherapy to prevent the reoccurrence of HER-2 positive. In previous years the drug has been prescribed by the NHS for women with late-stage cancer. But , Roche, its producer has just lately applied to the National Institute for Health and Clinical Excellence for its agreement to use the drug in first stage cases.
Mrs E from Cheshire was Six months’ pregnant when she first noticed she had a lump in her right breast. ‘My Doctor first thought the lump was a blocked milk duct’, she said. But it didn’t go away and after I had my baby I mentioned it during a routine check-up. She was then referred to a consultant.
The consultant diagnosed her with HER-2 positive breast cancer, but she lives in Manchester a region where Herceptin was not offered by the local health trust. Happily for her she had health insurance through BUPA which was prepared to pay for the treatment on her specialists recommendation.
She says, ‘If I’d been told I couldn’t have it, I would have been devastated. When you are in shock and fighting to get better, you don’t need another struggle for the best drug to help you.’
There is a chance that Herceptin could cause heart failure, so Bupa is carefulcautious to fund the treatment only when the resolution to use it has been made jointly between the patient and her specialist. A spokesperson from Bupa said: ‘Many drugs have potential side effects. We never make a decision to consent to any explicit treatment without getting substantiation of its potential benefits. We now think we have made an appropriate review. And other medical insurers have made the same decision – parts of the NHS have now decided to fund Herceptin in the first stage of HER-2 positive breast cancer.’
But not every medical insurance companies will cover the expenditure of Herceptin. Axa PPP says: ‘Our policies provide for the treatment of acute conditions which are likely to respond rapidly to medication. In the case of cancer, this can involve surgery, radiotherapy and chemotherapy. Our company will not pay for treatment where there is no proof of it being effective. For this reason we do not pay for the use of Herceptin treatment of breast cancer that has not accelerated (that is the cancer remains a primary disease). AXA is conscious of new 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 scrutiny.
Bupa advocate that women who want to make sure they are fully covered for the use of Herceptin should put to their health insurer the next 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 specialist accreditation does the treatment need to make sure that you are diagnosed and taken care of?
4. Will they cover you to use Herceptin for both the initial and latter stages of cancer? If so, for how long?
5. A what stage of the treatment would the medical insurance company stop paying for cancer care?
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