Insurer pays for Herceptin

AXA PPP Healthcare has agreed to cover the cost of the groundbreaking breast cancer drug Herceptin. Policyholders will be covered for 12 or 36 months, depending on what cover they have.

This follows the recent decision by the Government's drugs watchdog, the National Institute for Health and Clinical Excellence (NICE) to licence the drug for use in the early stages of breast cancer. This vital preventative treatment typically costs up to £26,000.

AXA PPP healthcare will backdate cover for Herceptin treatment to May 22, when it was licensed in Britain. NICE has fast-tracked Herceptin's approval for use by the NHS.

Bupa, WPA, Norwich Union and Standard Life Healthcare will all pay for the drug's use and have been covering their customers who were recommended the drug by their cancer specialists since last year.

Legal & General Healthcare , which provides private healthcare to more than 100,000 people, has confirmed it still refuses to cover the cost of the treatment. They consider it a preventative treatment, which policies are not designed to cover, so will not pay for Herceptin in primary breast cancer cases.

Cancer experts say that making Herceptin available across the UK to women in the early stages of breast cancer who are HER2 positive will save hundreds of lives. HER2 is an aggressive form of cancer, which affects about a quarter of all breast cancer cases.

Even for those insurers who will pay for the drug, the position is not simple. Some may not pay for the drug if it is readily available on the NHS.  Insurers generally pay for the use of Herceptin in cases of secondary cancer where the cancer returns after the initial treatment. In these cases the cancer has usually spread to other parts of the body. But the drug needs to be administered monthly, usually for a year or more. Some health insurance policies have cut off points for the length of time treatment is covered. Some will pay for acute problems, but not long-term treatments that are regarded as chronic.

Herceptin should be available on the NHS by the Autumn. The breakthrough follows high-profile legal battles by sufferers who fought for their local NHS to pay for the drug.


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Insurer pays for Herceptin
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