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Friday 28th October 2016

Cancer drugs, who should pay?

2nd July 2008

Ilora Finlay, professor of palliative medicine at Cardiff University School of Medicine, writes in OnMedica about the issue of who should pay for cancer medication.


The idea of co-payment is already existent in the health service. According to the Department of Health’s online information: “Entitlement to help with health costs (NHS prescription and dental charges, optical and hospital travel costs) is based on the principle that those who can afford to contribute should do so, while those who are likely to have difficulty in paying should be protected”.

NHS patients are charged for prescriptions in England and for dental treatment, optical tests and other treatments. Patients can be deemed to be exempt from paying, but there is an "underlying" expectation that people should pay.

These tests are for routine treatment, not life-saving cancer care. A cancer drug can mean the difference between life and death for a patient.

Patients will try to obtain drugs even if there is only a minute chance that it will make them live longer.

Another problem is the fact that "the episode of care is not clearly defined, so it is open to widely varying interpretations around the country".

Questions must be asked about cancer treatment - will costs only be for the medication or will they also include other services? Will they need to include ambulance journeys to and back from the hospital?

What happens if the patient has a low number of white blood cells and could develop serious infections – will emergency treatment costs also be accounted for?

Another issue is that this is considerably expensive medication, costing far more than the treatments currently subject to the co-payment system.

Many people who are against the idea of co-payment for cancer medication are afraid that it could discriminate against poorer patients, where only patients who can afford to co-pay for the treatment are able to receive drugs.

As technology progresses, the demand will escalate for the opportunity to buy new and better treatments to extend life.

How could this work? One option would be to "sell the drug or device at retail cost to the patient and to run a fund into which is paid the difference of the price to the NHS (cost price) and the price charged to the patient (retail price)".

Those patients who could not pay would be able to make use of the fund, which would be added to by charity events.

It is important to set down the boundaries of what the health service's function is and what it is not.

We must pay attention to those "very ill" patients who want medication that could extend their lives.

They should have the option of buying medication through the health service even "if the evidence is uncertain".


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