Herceptin

This drug has been the subject of considerable publicity recently, following the publication of an American study suggesting that, when given to some women following treatment for breast cancer, it greatly improves their chances of avoiding reoccurrence. Unfortunately, it comes at a very high cost; around £25,000 for a course of treatment.

As so often happens in such cases, medical insurers and the NHS have immediately been put under pressure to meet the extra cost, before having had time to properly consider the evidence. The NHS has said that it will not pay, but will fast track the drug through its existing evaluation process. This has not stopped one patient successfully bringing an action against her local health authority to force it to permit treatment with the drug. Medical insurers in general have said that they will meet the costs, but there are two significant exceptions in AXA PPP and CIGNA. Various national publications have lost no time in branding them the 'bad guys' for seeming to put their own profits before the interests of women stricken with a dreaded disease.

But is their position so unreasonable? CIGNA has long been reluctant to pay for extensive cancer treatment, but AXA PPP has for some time been willing to pay for Herceptin when used as a means of actually treating the disease in its advanced stages. Their objection is to paying for its use in circumstances where the patient has been treated by other means and, as far as can ever be determined, has been cured. What is more, like any drug, it has side effects: in this case, encouraging the development of circulatory problems. So, in the worst case scenario, a women whose cancer would not have returned, even without application of Herceptin, could develop another, quite unnecessary, disease as a result of taking the drug. And all at a cost of £25,000!

The case highlights the difficult balance faced not only by insurers, but also by anyone managing a corporate medical plan. We want our members to have the best medical care, but we are also reluctant to pay double digit increases in premiums and expect insurers or administrators to control costs. At the same time, we all want to believe in the power of 'wonder' drugs and other procedures, when the truth is rarely this simple. The fact in this case, however, is that AXA PPP looks increasingly as though it is losing the publicity battle with its main rivals. It seems difficult to believe that this is a price worth paying, even when compared to the cost of the drug. We predict that they will end up in line with others before very long!

The information contained in this document is of a general nature only and should not be relied upon as advice in any specific situation.

For further information, please telephone your usual contact at Buck Consultants (Healthcare):

Tel: +44 (0)118 955 7700
Fax: +44 (0)118 955 7701
Email: healthcare@buckconsultants.com
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