Thanks to increased and improved screening, middle aged people who get cancer have an improved chance of survival and recovery. Cancer treatment can last for a long time. The cost to the NHS and private medical insurance companies is considerable.
The number of cancer treatments now available is in itself causing a problem. More than 20 cancer treatments that have been licensed for use in Britain because of their significant clinical benefits are being denied to NHS patients because of bureaucratic delays. They include drugs for cancers of the breast, colon, bone marrow, lung, non-Hodgkin’s lymphoma and brain tumours. Some delays are as long as three years. Charity CancerBACUP, calls for radical reform to the appraisal process to reduce the time between a treatment receiving its licence and reaching patients.
The National Institute for Health and Clinical Excellence (Nice), which provides “best practice” guidance to the NHS, has admitted that government cuts have created serious delays with some of its assessment programmes. The list includes drugs such as Arimidex, a medication for early stage breast cancer in post-menopausal women that has been shown to be 25 per cent more effective than the most commonly used “best practice” treatment, tamoxifen.
Whether or not a private medical insurance policy includes cancer, and what expensive treatments and drugs the insurer is prepared to pay for, is not straightforward. Even if a policy includes cancer, what insurers will pay for is still often a matter of negotiation. Some insurers make it clear that although they will pay for initial tests and diagnosis, they expect any long term cancer treatment to be carried out under the NHS. Most insurers are not clear whether or not a policy covers cancer, and for what. Cancer charities have criticised this lack of clarity
One of the most controversial reasons to refuse a claim is to say that treatment is preventative rather than curing the problem. But it's arguable whether something is preventative or not. Chemotherapy and radiotherapy can be classed as preventative cancer treatment, yet policies usually cover them. But new drugs that also inhibit cancer from spreading, such as Herceptin, are called preventative by some insurers but not others. Some insurers have made their attitude on cancer or particular drugs clear.
In the UK one in four newly-diagnosed breast cancer patients has HER2 positive cancer and whilst the drug is expected to be approved by the National Centre for Clinical Excellence (NICE) in 2006, the NHS currently only provides Herceptin for advanced stage HER2 positive breast cancer.
CIGNA HealthCare is funding the use of Herceptin for sufferers diagnosed with HER2 positive early stage breast cancer. Herceptin, (trastuzumab) has shown significant efficacy in the treatment of HER2-positive breast cancer and appears to provide greater benefit the earlier the drug is taken according to recent clinical trials. Mike Soukop , CIGNA's Medical Oncologist says:” The recent evidence of the benefit of adjuvant Herceptin in breast cancer therapy is compelling. Therefore as part of the continual monitoring process of newer evidence based treatments, we have already approved the use of adjuvant Herceptin for patients with HER2 positive breast cancer."
CIGNA is working to provide a patient focussed approach to the administration of Herceptin by utilising specialist nurses to administer the treatment to patients in the comfort of their own surroundings. Eliminating hospital trips and stressful visits to the chemotherapy unit, this personalised, discreet service allows treatment to continue with a minimum of disruption to normal day-to day activities.
Dr Natalie-Jane Macdonald, Medical director, Bupa Insurance makes her company's attitude clear "We believe it is unacceptable for cancer patients to be let down in their hour of need when medical insurers refuse to pay for lifesaving drugs for their illness One of the main reasons why people buy insurance is to have prompt access to new effective drugs and other treatments, some of which may not yet be available on the NHS. Herceptin for early stage breast cancer, Cetuximab for bowel cancer and Tarceva for lung cancer are covered for Bupa members who need them. People should ask their insurer if these drugs are covered and whether there is cover should cancer recur at a later date"
You should ask insurers, what is their attitude to covering cancer and paying for drugs not available on the NHS.
