AXA PPP healthcare and cancer benefits

AXA PPP, the second largest health insurer in the UK, has made an abrupt about-turn on its policy towards the payment of benefit for the drug Herceptin. Unlike most of its competitors, AXA PPP had initially refused to recognise Herceptin in the treatment of early stage breast cancer, despite considerable publicity about its apparent effectiveness. AXA PPP's stance was largely based on the fact that the NHS had also not accepted it for widespread use.

All this has changed following the recent announcement by the National Institute for Clinical Excellence (NICE) that Herceptin should be permitted at any stage of treatment throughout the NHS. This appears to have been a factor in AXA PPP deciding that it will now provide benefit for treatment at any stage of cancer care with Herceptin and similar drugs. This said, the future criteria will be that the new drugs must be licensed by the European Medicines Agency. The position taken by NICE will no longer be relevant.

Herceptin is just the first of many 'monoclonal antibody drugs' that are about to become available. Rather than trying to aggressively destroy the cancer, the new drugs are able to stop cancer cells dividing and therefore prevent the growth of the tumour. As such, they avoid some of the unpleasant side effects of previous chemotherapy drugs, but may have to be taken over a much longer period, in some cases for life. They are also all very expensive! £30,000 for a year's course is about par for most of the new drugs.

In the face of this, AXA PPP has decided to offer members, group and individual, a choice as to whether they want to include these treatments in their benefit package. From October 2006, corporate customers will be offered options on renewal that range from no cancer benefit at all to full access to the new therapies. The likely additional cost of funding the top level option is approximately 2% on top of current medical inflation.

In the meantime, AXA PPP is prepared to give everyone in its plans up to 12 months' coverage with the new drugs, including Herceptin. It has committed not to change premium rates already agreed, but it will be allowing large corporate clients to refuse the new benefits if they so wish. Clearly, health trusts and other cost plus plans will be facing immediate cost consequences if they embrace the change.

We expect that most employers will be happy that AXA PPP has made the change and will be prepared to accept the costs of making the new therapies fully available to their members. While it is useful always to have choices, we should not forget that most other insurers have taken the view that full access to cancer treatment is an essential part of their standard products.

If you are an AXA PPP client, you can expect to get a communication direct from them in the next week. Your Buck representative will be on hand to help you understand the new ruling and, where necessary, assist your company in making the right decision.

THE INFORMATION CONTAINED IN THIS DOCUMENT IS OF A GENERAL NATURE ONLY AND SHOULD NOT BE RELIED UPON AS ADVICE IN ANY SPECIFIC SITUATION

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