Cancer treatment unavailable in UK

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A friend of my girlfriend is living in the UK and was diagnosed with lung cancer. Her oncologist suggested to treat her with a drug which is not available in the UK for that indication (or at least will not be paid for by the NHS) and is very expensive (EUR 7600 per month), so she cannot afford it. In Germany the drug is available. Could she (as a EU-citizen) come to Germany and get treatment here (i. e. get a prescrition) without having to completely move and leave her family (husband and 9 year old daughter) behind? In other words: Would the NHS reimburse the cost for drugs prescribed by a German doctor even if they are not recognized in the UK for a specific indication?

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Sorry that I can't help you with more specific information, but here are some links that I found:

 



  • here, that's the NHS section on treatment abroad, and
  • here is the web site of the European Commission on "Planned treatment in another EU country"

 

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No sorry, I don't think that's possible. If the NHS won't pay for the drugs they won't pay for them regardless of whether they're prescribed in the UK or Germany. You can go abroad (from the UK) for treatment in certain circumstances, but payment has to be pre-authorised. It's unlikely that a German doctor would agree to prescribe in these circumstances anyway I would have thought.

 

If the drug is approved for that use in the UK and it's a question of cost, then PCTs (or whatever they're called these days) can decide to pay if they have the money and they think that an individual case warrants it. They will only do this in a very few cases though because it sets a precedent and I suspect they mostly can't afford it these days. It's worth asking them though. The oncologist ought to be able to help here. Also there are various funds available that she could apply to - again her oncologist should be able to advise on this. The final resort is to go through the courts and try to get a court ruling forcing them to pay. People have tried this, but only a very few cases have been successful, and like anything to do with the legal system it takes time...

 

If the drug is not approved for that purpose in the UK, then that's off licence prescribing. I think that the only way she could do that would be to try to get on a drug trial if there's a suitable one available and I guess her oncologist would already have suggested it if was an option. Doesn't hurt to ask though.

 

Sorry. I think that their best bet is to look for help with the cost within the UK.

 

Disclaimer - it's a while since I had anything to do with this and it's possible that things have changed. Your friend should seek advice from people in the UK who know the system and get second, third, fourth, fifth opinions on the funding. You never know - someone may find a loophole.

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I have personal experience of this, though not for cancer (I've had a headache all day every day since the 16th October 2010) and when we were all out of treatment options on licensed drugs in the UK, I was given a private prescription for a drug used all over Europe, but it was never licensed in the UK. Not because it was deemed unsafe, but because the manufacturers never registered it for use in the UK or the US. As it was a private prescription, I was liable for the cost - even though I had private health insurance through my previous employers, as it was deemed "outpatient medication" then it wasn't covered on that. Thankfully it wasn't as expensive as the OP's friend though.

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Thanks for all your input.

 

Shouldn't it be possible for her to officially move to Germany, register here and get health insurance from a public provider? Do they have to accept a foreigner from the EU? Wouldn't that solve her problem (provided she finds a German oncologist willing to prescribe the drug)?

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What are the chances of medical insurance in Germany taking her onboard with such an existing condition?

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A public insurer would have to insure her I believe. I'm not sure whether she'd be able to get in without a job though.

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What are the chances of medical insurance in Germany taking her onboard with such an existing condition?

 

Public health insurance doesn't ask health questions.

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An EU citizen can, as far as I know, also apply for German health insurance if they are looking for a job and register as unemployed.

 

However, it may be hard to convince them that she is actually looking for work if she is suffering from cancer. They may well see through this as a ploy to getting better treatment at the expense of the German healthcare system (which this actually is).

 

Not wanting to sound like a prick here, because obviously someone with a life-threatening illness will do whatever it takes to get better (I know I would too) - however, it shouldn't be the responsibility of the German health system (and those contributing to it) to pick up the tab for deficiencies in another country's health care system.

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I also wonder if the drug, although available in Germany, would in fact be offered to everyone, particularly those on public insurance. It may well be available, but not covered or only partially covered by insurance. I'm not sure how you would go about checking that.

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It may well be available, but not covered or only partially covered by insurance. I'm not sure how you would go about checking that.

 

The Arzneimittel-Richtlinie would probably be a good place to start.

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My father was diagnosed with Pulmonary Fibrosis last year. This is degenerative and the outcome is usually very poor. At this time he was told there was no drug that arrested the condition, but some to help with symptoms. I did research and found a drug licensed in Japan that was in clinical trial in Germany and was due to be approved in the later part of last year. The drug is expensive (+20K€ per annum). I too wondered if there was a way to have this prescribed here, but for the reasons others state there is no loophole.

 

In our case, the drug has since been licensed in the UK, but is still waiting for NICE approval (costs) and therefore is not generally available. Through internet research I found a group in Liverpool conducting a limited study and I provided all this information to my fathers specialist. He subsequently recommended my father for consideration and last week he was enrolled on the programme. The study is funded by the pharma company and the drugs provided for a much reduced cost. However, there is no guarantee this does not change in the future.

 

Perhaps there may be a similar alternative for your circumstance?

 

Best of luck,

Jono

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I heard that in the past people who required immediate surgery but were on an endless waiting list in the UK were given the underhand advice "go to Paris on vacation and then collapse on the sidewalk". Supposedly the French would not send people home in such a precarious state and treat them instead. This may just be an urban myth, though. Probably it's also easier to pull off for something that requires immediate surgery rather than a prolonged cancer treatment.

I don't see any real option for her to get treatment in Germany other than coming here for work or study and being covered by German public insurance.

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Shouldn't it be possible for her to officially move to Germany, register here and get health insurance from a public provider? Do they have to accept a foreigner from the EU?

Yes, they would have to accept her, see §9 SGB V Absatz 1 (membership in an EU public health insurance counts the same as in a German one): http://www.sozialgesetzbuch-sgb.de/sgbv/9.html

 

However, you should first check 2 things:

 

  • will German public health insurance pay for this drug?
  • will you find an oncologist willing to take such a hit in the monthly drug budget that he gets from the public health insurers, just for 1 patient?

 

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If she gets a disability pension in the UK - wouldn't the NHS have to reimburse the cost of her treatment to the German public insurance? And wouldn't that mean an oncologist wouldn't have to take a hit in his budget?

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The oncologist would still take that hit, she would have the same German Versichertenkarte as everybody else.

 

Would that disability pension be a long-term incapacity benefit?

http://www.nhs.uk/NHSEngland/Healthcareabroad/movingabroad/Pages/Livingabroad.aspx

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If she comes over from the UK, stays long term with someone, anmelds and doesn't work, can't she go through the thing that used to be form S1, where the TK or whoever take her on at British expense? Not that I have the smallest clue how it works in practice.

 

Desperate situation, I hope she finds a solution.

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Thanks for all your input.

 

Shouldn't it be possible for her to officially move to Germany, register here and get health insurance from a public provider? Do they have to accept a foreigner from the EU? Wouldn't that solve her problem (provided she finds a German oncologist willing to prescribe the drug)?

 

I know, thats what I was thinking. But it sounds too easy and good to be true. Come to Germany, get an unskilled part time job (if you're able), live in a youth hostel, get publicly insured from day 1, then quit. Somehow it sounds absurd, yet not absurd at the same time. That can't be right, surely.

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If she comes over from the UK, stays long term with someone, anmelds and doesn't work, can't she go through the thing that used to be form S1, where the TK or whoever take her on at British expense?

 

I was thinking of suggesting something along these lines. But as Panda rightly pointed out, there are other questions to check beforehand, otherwise she might undergo the trouble manage to get into the German system but still not get the medication her oncologist suggested.

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I heard that in the past people who required immediate surgery but were on an endless waiting list in the UK were given the underhand advice "go to Paris on vacation and then collapse on the sidewalk". Supposedly the French would not send people home in such a precarious state and treat them instead. This may just be an urban myth, though.

Isn't that the oddest thing because (despite the NHS's poor reputation) that is exactly what I heard years ago:

Same sentence but just exchange Paris with England...

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