The high cost of cancer drugs continues to test the ability of both the NHS and private medical insurance (PMI) providers to devise sustainable funding strategies.

One year on from the publication of his report Improving Access to Medicines for NHS patients, there are already signs that national cancer director Professor Mike Richards’ recommendations may not stem the need for patients to seek private funding.

In October the National Institute of Health and Clinical Excellence (NICE) declined to approve the use of a breast cancer drug to treat patients with advanced disease, despite the manufacturer’s proposal to pay for the drug for up to 12 weeks and the creation of more lenient rules for the assessment of end of life drugs in the wake of the Richards report.

However, the past year has also highlighted the challenges facing the PMI industry, once regarded as a potential beneficiary of the report’s recommendations.

WPA’s My Cancer Drugs “exceeded expectations”, according to the insurer’s corporate communications director Charlie MacEwan, yet it is now only available as one module of a broader Health Top-Up product. MacEwan’s admission that the corporate market generates the majority of demand for this offering, and that hospital and wellness benefits are the most popular, indicates that My Cancer Drugs may not generate significant amounts of income for the insurer.

Over the past twelve months, other PMI providers have promoted comprehensive cancer cover as a key benefit for members.

In its recent report on top-up fees the Health Select Committee backed moves to allow patients to privately fund drugs not recommended by NICE, without placing their NHS care at risk.

But it said it was concerned that the proposed separation between private and NHS care could result in patients being moved, ‘so as to administer a privately paid for drug separately’.

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‘This undoubted disruption to a patient’s quality of life just to meet some bureaucratic requirement would endanger the patient’s care,’ it said.

Speaking at Laing and Buisson’s annual PMI conference, Professor Karol Sikora, medical director of Cancer Partners UK, predicted that the existing NHS funding model would never be able respond to the growth in expensive medical innovations.

“The need for top ups has been dampened but it is going to come back with a vengeance,” he said

Highlighting poor access to targeted radiotherapy and a pipeline of 40 new drugs (at a cost of up to £100,000 per patient), Professor Sikora, currently developing a network of independent cancer therapy centres, warned that in the current NHS “not everybody can have everything”, making the involvement of the private sector inevitable.

The conference took place in the same week that the parliamentary Health Committee raised concerns that the implementation of top-ups guidance could result in the emergence of a two-tier NHS. The report on top-up fees also described the new guidance on approving endof-life drugs as an “inequitable and an inefficient use of NHS resources,” highlighting the finite funds available to the Department of Health (DH).

The committee expressed doubts about whether the principle of delivering NHS and privately-funded care separately was even feasible, fuelled by evidence from the Royal College of Physicians and a claim from one NHS chief executive that it was “naive” and “simply not possible”.

Some NHS managers have warned that unless the limit is scrapped, they will have to send top-up patients elsewhere.

But while South Tyneside Foundation Trust has a small cap of 0.1 per cent of its total yearly income and budget, it has only received private income of 0.06 per cent as of January.

The biggest concern about the caps for some trusts was the change in the law to allow NHS patients to ‘top-up’ their state-funded care with private healthcare paid for separately.