medical-insurance/"> medical insurance   has been paying for the miracle drug Herceptin which has been used by several breast cancer patients after the NHS refused to perscribe them Herceptin.

During the last year BUPA has provided Herceptin to about 100 ladies who were acknowledged as being in the first stages of the deadly HER-2 positive type of breast cancer.  At the same time Standard Life has reportedly paid for the same drug in 30 cases in the initial development of breast cancer. And since the previous year Norwich Union has also provided for Herceptin in early stage cases.

Recently 2 ladies with initial stage breast cancer went to the High Court in an effort to to get hold of Herceptin for treatment through their health trusts. The difficulty is that Herceptin is so expensive. It costs in excess of 20,000  pounds for a year on Herceptin and some hard up have basically declined to find the money for the drug, even though Patricia Hewitt the Health Secretary, has commanded them to make it available if doctors feel it will help.

The drug is used subsequent to surgery, radiotherapy and chemotherapy to prevent  the reoccurrence of HER-2 positive. In previous years the drug has been prescribed by the NHS for ladies 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 initial stage cases.

Mrs J S from Manchester was Six months’ pregnant when she first realised she had a lump in her right breast. She said, ‘My local Doctor first thought the lump was a blocked milk duct’. 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 specialist diagnosed her with HER-2 positive breast cancer, but she lives in London  an area where Herceptin was not offered by the local health trust. Happily for her she had medical insurance through BUPA which was prepared to pay for the medicine on her consultants recommendation.

’If I’d been told I couldn’t have it, I would have been devastated’ she said. When you are in shock and fighting to get better, 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 treatment only when the judgment 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 drug without getting proof of its possible benefits. We now think that we have made an appropriate analysis.  And other private health companies have made the same decision – branches of the NHS have now decided to pay for Herceptin in the initial stage of HER-2 positive breast cancer.’

But not all health insurance companies will cover the expenditure of Herceptin. Axa PPP says: ‘Our insurance policies provide for the treatment of serious conditions which are likely to respond swiftly to drugs. With cancer, this may include surgery, chemotherapy and radiotherapy. 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 escalated (that is the cancer remains a primary disease). AXA is aware of fresh 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 advise that ladies who want to guarantee they are fully covered for the use of Herceptin should ask their medical insurer the following five questions:

1. If I get breast cancer and it then spreads to my lungs – Will they cover me for secondary cancer?

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

3. What professional accreditation does the treatment need to make certain that you are diagnosed and treated?

4. Will the insurer cover you to use Herceptin for both the initial and late stages of cancer? If so,how long would this go on?

5. When would the insurer stop paying for cancer treatment?

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