Cancer Control in New Zealand

Herceptin

The Prime Minister announced 12 months funding for Herceptin for patients with early stage breast cancer on 10 December 2008 .

Information on the Funding 12 Months Herceptin policy is provided below:

For more information about Herceptin please contact your specialist.

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Questions and answers for patients

What is the Funding 12 Months Herceptin policy?

The Funding 12 Months Herceptin policy means that the Ministry of Health will fund 12 months of Herceptin (trastuzumab) therapy for eligible patients with early HER2 positive breast cancer.

Previously, only a 9 week course of Herceptin was funded for treatment of early HER2 positive breast cancer.

This policy is part of the Government’s Post-Election 100 Days Action Plan.

When is this policy effective?

This policy became effective on 19 November 2008 (the date the Government was sworn in). It becomes operational from 10 December 2008.

Am I eligible for 12 months of Herceptin treatment?

You are eligible to receive publicly-funded Herceptin treatment for up to 12 months if:

you are eligible to access publicly-funded health services in New Zealand - to check your eligibility, go to: www.moh.govt.nz/moh.nsf/indexmh/eligibility-guide

AND
you meet certain medical criteria, including having a diagnosis of early HER2 positive breast cancer. Your specialist will assess you to determine whether you meet the medical criteria.

Do I have to have 12 months of Herceptin treatment?

No. You can choose between receiving a 9 week or 12 month course of Herceptin. Your specialist can help you decide the best treatment option for you.

What are the advantages of having 12 months of Herceptin treatment?

The risks and benefits of having 12 months Herceptin treatment are different for every patient. You should discuss this with your specialist who can help you decide the best treatment for you.

What happens if I already completed 9 weeks of Herceptin treatment?

You may be able to continue to receive the balance of 12 months publicly-funded Herceptin treatment, depending on when you finished your 9 week course of Herceptin. You should discuss this with your specialist.

What happens if I am part way through a 9 week course of Herceptin treatment?

You can choose to extend your Herceptin treatment for up to 12 months. You should discuss this with your specialist.

What happens if I didn’t complete my privately-funded 12 month course of Herceptin treatment?

You may be able to complete the balance of the 12 month course through a public provider, depending on when you stopped your previous Herceptin treatment. You should discuss this with your specialist.

What happens if I have already completed a privately-funded 12 month course of Herceptin treatment?

If you finished your 12 months of privately-funded Herceptin treatment before 19 November 2008, you will not receive any refund.

If you received privately-funded Herceptin treatment between 19 November 2008 and 10 December 2008, the Government will refund you the total cost of Herceptin treatment received between 19 November 2008 and 10 December 2008 (excluding any costs paid by your insurance company). This refund will include any additional delivery costs. Only individual patients can receive this refund; insurance companies are not eligible for the refund.

What happens if I am part way through a privately-funded 12 month course of Herceptin?

If you need to continue your 12 months Herceptin treatment after 10 December 2008, you must decide whether to:

transfer to your local District Health Board for fully-funded treatment, or
continue to receive treatment from your private provider and pay some of the treatment costs yourself.

If you choose to transfer to your local District Health Board to receive your remaining Herceptin treatment after 10 December 2008, you should stop paying for any Herceptin treatment administered by your private provider after 10 December 2008. The Ministry of Health will pay for the total cost of Herceptin treatment (excluding any costs paid by your insurance company) from your private provider while you are waiting to be transferred to your local District Health Board.

If you choose to continue your remaining Herceptin treatment through your private provider after 10 December 2008, the Ministry of Health will only pay for the public drug cost of Herceptin. The Ministry of Health will not pay for any additional delivery costs charged by the private provider. You or your insurance company will need to meet these additional costs. You should contact your private provider to find out the amount of these additional costs.

Who can I contact to arrange publicly-funded Herceptin treatment?

Contact your specialist.

Can I get a refund for privately-funded Herceptin treatment received between 19 November 2008 and 10 December 2008?

Yes. If you received privately-funded Herceptin treatment as part of a 12 month course between November 19 2008 and 10 December 2008, the Ministry of Health will refund you the total cost of Herceptin treatment received between 19 November 2008 and 10 December 2008 (excluding any costs paid by your insurance company). Only individual patients can receive this refund; insurance companies are not eligible for the refund.

There is no refund for Herceptin treatment received before 19 November 2008.

How do I claim reimbursement for privately-funded Herceptin treatment received between 19 November 2008 and 10 December 2008?

Send your contact details (including a telephone number), bank details and receipts of payment for Herceptin treatment received between 19 November 2008 and 10 December 2008 to:

The Cancer Team
Sector Capability and Innovation Directorate
Ministry of Health
PO Box 5013
Wellington

If you have any queries, please contact the Cancer Team:

Email: cancerteam@moh.govt.nz
Ph: 04 496 2000

Can I still be part of the SOLD trial?

Yes. New Zealand patients receiving 9 weeks or 12 months of Herceptin can continue to participate in the SOLD (Synergistic or Long Duration) trial. This trial is comparing the effectiveness of 9 weeks and 12 months Herceptin therapy.

Related media releases

Prime Minister's media release - Government honours Herceptin promise (www.beehive.govt.nz)

Minister of Health's media release - 12-month Herceptin treatment now available (www.beehive.govt.nz)

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Page last updated: 10 December 2008