Insurance with drugs licensing under spotlight

by Brian Turner

Story link: Insurance with drugs licensing under spotlight

Health care professionals and insurers in the UK are trying to sort out the difficult question of who is to pay for new and expensive drugs for patients with serious conditions, sometimes before the drug has been licensed and is only being used on an experimental basis.

It is a controversy currently being negotiated in regard to Herceptin, a drug for a particular kind of breast cancer known as HER2 positive breast cancer, which primarily affects younger women. The drug has been available thus far only to women on NHS who have an advanced case of the disease.

Recent studies, however, have shown that Herceptin can help patients at an earlier stage than had been thought. But the question arises, what about women who have private health insurance?

The insurers have very diverse answers to that question. Some will pay for the drug for women who have just been diagnosed, but others will only pay for the drug for women with advanced cases of the disease. Others still have not decided how they will proceed.

In addition, because the drug is so effective, another problem has arisen - how long should insurers pay for the drug when women taking it are living longer?

The problem is that at present, private insurers in the UK cover only acute conditions, and some of them are declining to fund the drug, calling it a chronic treatment for a chronic condition because the treatment goes on longer in women who are helped by the drug.

On the other hand, some medical experts argue that the insurers should cover the drug because if given in the early stages of the disease, there is a higher likelihood that the patient will be cured in a shorter period of time and at less expense than waiting until the disease is more advanced and a cure is less likely.