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Insurers are offering cover for the cost of drugs not available on the NHS, as the government announced last week that people who “top up” with private treatment will not have to forfeit state care.
Before the change, thousands of NHS patients, including cancer sufferers, were denied drugs that could prolong their lives because the National Institute for Health and Clinical Excellence, the government’s drug-rationing body, ruled they were not good value for money. Patients who chose to use their savings to pay for drugs had their NHS care withdrawn.
The announcement last week, however, means you can now pay for part of your treatment privately so long as the work is “separate” from the NHS.
Before the announcement, the only viable way to receive the drugs, which can cost as much as £50,000 a year, was to pay for private medical cover.
Bupa, for example, provides access to cancer drugs not available on the NHS as part of its heart and cancer policy.
It would cost about £22 a month if you are a healthy 40-year-old non-smoking male or female, with an excess of £500 on the policy. The annual cost is therefore around £264.
The cover will pay for non-NHS drugs such as Avastin, Tarceva, Erbitux and Stutent, or “any other drug the patient may need”, according to Bupa.
However, you can now take top-up cover through WPA, a health insurer which provides access to the drugs for an annual premium based on your age plus 5% insurance premium tax. If you are a smoker, you double your age for the calculation. For the above example, the annual premium would be just £42 — a saving of about £222 compared with the Bupa cover.
As with Bupa, the insurance will pay for drugs such as Avastin, Tarceva, Stutent and others although it will not provide access to private consultants.
Healthcare at Home (HAH), one of Britain’s largest providers of medical treatments at home, serving about 100,000 patients, welcomes the change. Last year, about 1,000 of its patients paid for some element of their NHS care.
A spokesman said: “Before this change only 30 out of about 200 NHS hospital trusts around the country allowed patients to pay for their own treatment without penalising them.”
Other insurers are now considering offering top-up insurance policies. Fergus Craig, commercial director of Axa PPP healthcare, said: “This is excellent news for patients and their families. We will be studying the new guidance carefully to ensure our top-up offering fully complements their NHS care. We expect to make this available very soon.”
WPA offers two types of top-up cover. My Cancer Drugs, which, as the name suggests, pays out for cancer drugs not available on the NHS.
The other option, which was launched last month, is called Health Top Up, which costs £15 a month for its basic Wellness product.
This will cover you for up to 75% or £150 a year for treatments such as dental and optical work.
You will also receive £200 maternity/paternity cover each time you have a child.
You can add to the policy to cover the costs of your stay at a hospital, including the cost of parking, telephone calls and even magazines. The additional “hospital” cover costs another £2.50 a month on top of the Wellness fee and it will pay out £60 a day for 20 days of the year.
The hospital cover also pays private consultant fees if you want a second opinion, but don’t want to wait in line for an NHS doctor. The cover will pay up to £250.
Bear in mind, though, that there are exclusion periods when you start the policies, during which you cannot claim.
With the maternity/paternity cover, for example, the exclusion period is 10 months. With cancer drug treatments, there is a 90-day exclusion which means any drugs for cancers diagnosed during this time will not be covered.
There is a one-month exclusion on the hospital policy although A&E attendance is exempt from this.
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