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Private health care with Bupa

Hi.
I have just found out that if you have cml and are treated by the nhs and are treated as we are with TKI's then they may pay a cash benefit for the treatment if you have the right type of cover. This can be backdated to 2012 which is when the scheme started.

Hi yes BUPA pay £100 per course of TKI, eg every month, also £100 for each BMB.Consultant needs to sign the form from BUPA and need a hospital stamp, very easy claim, and does not effect renewal premiums. They pay it as £100 a month is a alot cheaper than circa £4000 a month for TKI's and doctor to over see you, PCRs, bloods etc so on.

Out of interest, do BUPA pay directly for TKIs for the long term? PruHealth, for example, have a policy of paying only for 12 months.

I have been getting some payments from Bupa. They pay £100 per NHS prescription, not per month. The best ruse seems to be to get your 3 month supply issued in three separate prescriptions. They also pay £100 for each NHS "treatment" visit. Their oncology group will email the form to you.

A few years ago, Bupa told me over the phone that they would pay long-term, but I haven't put it to the test.

Thanks. It's interesting to know, because I am in a bit of a battle right now with PruHealth about payment for Dasatinib. They say they will stop paying in about 5 or 6 weeks. Not great.

David,

you can get dasatinib via (your doctor's) application to the CDF- not a complex form for him/her to fill in. No need to battle with private health ins.

Sandy

Hi David,
Having had experience of using private health cover for the treatment of CML I thought it might be helpful to respond in respect of your insurer Pru Health that has indicated that they will cease to pay for Dasintinib in 6 or 8 weeks time.
When I was dx with CML in Feb 2006,7 years ago I used my insurance with AXA/PPP to locate a consultant to treat me on a private basis;it was at a stage when private insurers were starting to recognise that they should address the issue of treating cancers for longer periods than just the few months needed to diagnose a condition and give initial treatment.Hitherto insurers would soon dump patients arguing that the condition was chronic and long term and regretably insurers in the UK despite their new policies on cancer treatments still shy away from paying for monitoring and treating long term conditions.
It is fairly common practice for insurers to to have policies for cancer conditions and in particular for CML that specify that they will only treat the condition for one year and unusually they will fund the costs of the drugs such as imatinib or dasatinib or others on the basis that this treatment is equivalent to the costs of chemotherapy or is in fact in their eyes chemotherapy;private insurers for a range of other non cancer conditions will expect the patient to fund the private prescription or indicate that recourse to ones GP and the NHS is an alternative.As we know TKIs may only be prescribed by consultants.
The only exceptions to the one year practice/rule is where patients have subscribed to a premium service (if it is offered by the insurer)where the insurer will fund cancer treatment and drugs for the period time necessary-for TKIs for life unless trials like DESTINY conclude otherwise.
In my case I did not subscribe at the premium level of AXA/PPP so was cut off after one year.My consultant then took me on as an NHS patient and at one of his clinics where he would always see me rather than a specialist registrar or a locum.The insurer was very strict on not wanting to fund one day more supply of imatinib than they were obliged and the transfer process was fraught because I thought I would be without medication for a while.
My advice David would be to read the insurers policy conditions very carefully and if they indicate that only a certain period of time is funded to accept this as they will not make exceptions.I suggest that you make immediate arrangements with your existing consultant who is treating you privately to transfer you to him/her as an NHS patient or to a named alternative and to fix an NHS appointment as early as possible to arrange for an application under the NHS to the Cancer Drugs Fund for the continuation of treatment with Dasatinib.There is a bureaucracy in transferring from private treatment to the NHS and also a bureaucracy in applying for the Cancer Drugs Fund-my consultant indicated to me that the CDF is fiddly and has to be exactly in order for success first time/immediately.
Mixing treatments private and NHS is I believe still an issue so early action is important in order to maintain your supply of the drug.
As a general point, consultants have told me that there is a pecking order of insurers in terms of what they offer for certain conditions;AXA/PPP and BUPA seem to have the best reputations but would not wish to comment on the records of the others.
In my case I still subscribe to private health insurance even though being in my late 60 s premiums are not cheap.The main reason is that AXA/PPP have indicated that they will still pay for procedures and also for any alternative licensed drug(in my case) other than imatinib- I assume that if needed they would fund iclusig/ponatinib.However I assume the treatment would be for one year only.Then of course there is the issue of transferring from one sector to the other and then in the future back again.
I trust that my experiences will assist you in being able to maintain a supply of your Dasatinib.
I wonder if any other members have had similar experiences of transferring sectors?
Best wishes
JohnW1001

We are looking at that option (tomorrow in cliic, actually) but I do think that if the insurance company takes a bet, and loses, they should pay out. Their T&Cs clearly state that they ought to pay for it, but then when they see the price they don't want to. You win some, you lose some!

I just don't think that the NHS should have to pay when I have a policy that should be paying instead. At the end of the day, I just want access to the drugs but all the same there's the principle of it too!

Thanks John,

I'm already doing most of what you advise. I actually get seen on the NHS for everything except prescribing - all my clinic appointments and blood work is at Barts NHS hospital. So I'm not really only "in" the private system, or only "in" the NHS - I get my drugs privately, but everything else through the NHS.

I didn't do well on imatinib and didn't want the cumbersome dosing of nilotinib (my job is not very good with routine - I never really know when I'm going to get a chance to eat!) so taking dasatinib through my private insurance is the route we went down, with the view to transferring prescribing to the NHS in time. That's what we're planning on doing over the next few weeks.

In terms of the CDF, Steve O'Brien (Newcastle Hospital, who works with NICE) reckons I don't need to apply to it and it can just be prescribed on the basis that I am already taking it. My consultant at Barts is looking into this route too, which would be simpler. I hope they have an update for me at clinic tomorrow.

With regard to my insurance, the wording that they fall back on is this:

- They will pay for the duration of care for all chemotherapy, including oral chemotherapy
- They will pay for 12 months for any biotherapy, which is classed as the addition of a substance already naturally occurring in the body (e.g. interferon).

They are saying that dasatinib is classed as a biotherapy, but my consultant says it's oral chemotherapy. This is basically what it boils down to, and from my own reading it's somewhat inconclusive in terms of consensus! BMS don't use either term in their literature.

David.

Hi David,
Thanks for your response which is interesting from a number of perspectives.
Insurance companies it seems do not specify in detail their polices or approaches towards cancer treatments in their sales literature but seem to have a bottom drawer interpretation of what they will fund which they bring out at their convenience.
I seem to remember that in the travel insurance threads of this forum we have discussed the issue of whether TKIs are classed as chemotherapy treatments or as something else which as we know are often described as targeted molecular therapies-when responding to questions in medical screening exercises ought we to admit that we are taking chemotherapy drugs or not?If we say yes we are less likely to be taken on for travel insurance and if we say no perhaps we have a better chance of being offered insurance-but in the event of a claim how do we stand in terms of being accused of making a false declaration?
In the context of your insurer I suspect that they have invented the category of bio therapies as a mechanism to evade payment of treatments that may last a lifetime.Presumably most chemotherapy treatments for other cancers are shorter term for a specific cycle and not long term as for CML.
Furthering their line of argument they ,the insurers, may argue that imatinib etc inhibit the production of a kinase which itself is naturally present in the body and is therefore a biological inhibitor.
If your consultant is of the opinion that dasatinib is oral chemotherapy would you be able to persuade him/her to write on your behalf to the Medical Director of the insurance company to ask for a review of policy? The alternative would be to flag this up as an issue with one of the quality dailies that produce occasional articles on what private health insurers pay for /do not pay for-The Telegraph on Saturday has a Finance/Money supplement that has in the past dealt with such issues.
Health insurers are typically at home with hips and knees but try to avoid payment for conditions that are chronic and which require monitoring and treatment beyond the short term-however they fail to come clean with specific statements in their policies that they issue to subscribers.
In terms of the mix between private and NHS practices/treatments from what you relate there appears to be one running side by side with the other but I guess that if you had the procedures and tests funded by private health insurance and the drugs funded by the NHS then this would not be encouraged.In my situation 6 years ago when after one year on private treatment AXA/PPP would continue with the procedures but not the drugs my consultant said it would difficult for him to continue to treat me for private procedures and then for me to just turn up to visit him in his NHS clinic in order collect the prescriptions-ethically and operationally not possible.
Again thanks for your reply and please inform us of the outcome of whether you are able to access dasatinib on the NHS (without recourse to the CDF) as per NICE guidance that you have been on this drug on a previous basis.
Best wishes with the treatment,
johnw1001

> If your consultant is of the opinion that dasatinib is oral chemotherapy would you be able to persuade him/her to write on your behalf to the Medical Director of the insurance company to ask for a review of policy?

Yep - they've done that! I doubt it'll make much difference though.

I'll let the forum know what the outcome is. The plan is to avoid the CDF, but if we have to go there, then we have to go there! My oncologist seems fairly confident, but I think that there's a lingering concern that if it came to a CDF application then by the rulebook I would need to be nilotinib refectory (as well as imiatinib refectory, which I am) before I would be eligible for dasatinib.