Will private medical support biologics? Any experience please

LCMUM

Hi I’m new to the community, but was hoping some of you may be able offer some advice re. a situation I am in.

I am currently taking methotrexate & hydroxychloroquine for my RA and in January this year my consultant recommended that I should be treated with biologic therapy if this combination of treatment proved ineffective, which it has as my symptoms have not improved.

I am waiting for a follow up appointment through the NHS which I’d hoped would have been in May, unfortunately I am still waiting for my next appointment & the clinic are unable to advise when this will be.
In the meantime as I have private medical insurance I thought I’d contact them to see if they would cover the cost of biologic therapy through my policy. My provider hasn’t given me a clear answer as to whether they will or won’t cover this treatment & have at this point only authorised me to go back to see the rheumatologist who initially diagnosed my condition back in 2022, before transferring me across to the NHS for further care & after his clinical assessment will then advise.
I have contacted my private consultant & he has said in some circumstances some providers will provide cover in these instances.
I would be appreciative if anyone can share experiences of this situation to comment.

Thank you in advance

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Ellen

Good morning @LCMUM welcome to the online community.

I see you are struggling with long waiting list on the NHS and are considering seeing a private consultant to start biologic treatment for you Rheumatoid Arthritis.

To be honest I don't remember anyone having biologics prescribed privately although they may not have said so. A few have been prescribed other DMARDs like Methotrexate by a private consultant and then been referred back to the NHS.

Hopefully someone will be able to help you.

Best wishes

Ellen.

LCMUM

Thank you Ellen, I do feel this will be the outcome, my private consultant did prescribe methotrexate for me in 2022 & then transfer me across to the NHS but worth an ask if anyone has any insight.

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Arciere

hi there

My GP did explain that there is a process to convert a private prescription to an NHS prescription. I just don’t know what it’s called or how you’d go about it. I didn’t find success with it. Also my prescription decision for biologics apparently went to a committee for approval. I’m unsure if this was due to cost or the risk/benefit,

I just asked Chat GPT and it did talk about a form FP10. This might be worth a Google.

It seems crazy that in one hand we have a NHS that is purportedly under resourced or over used, and then employers and the public paying for private medical insurances, providing access to often the same consultants employed by the NHS, yet converting a private prescription to an nhs one is not completely clear. Surely the private sector can help relieve the pressure on NHS services ?!

Anyway - I hope this helps

LCMUM

Thanks I’ll take a look, think it’s complex & some insurance companies offer different levels of cover so that impacts what they will & won’t pay for & will cover short term only….

Appreciate your comment ☺️

Arthuritis

@Arciere @LCMUM Unfortunately electorates aren’t logical, and govts pander to electorates for votes.

So for example the private sector taking pressure off the overloaded NHS? - How dare anyone be more successful and use their private health cover? Punish them and their employer by having to pay insurance tax! Have them back on the NHS waitlist making it longer… There isn’t enough for everyone so the soup has to be watered down to spread it equally, ensuring everyone stays equally hungry!

A logical electorate would gratefully say: “Thank you to those paying their taxes but not using taxpayer funded services, instead generously paying again for those services privately”. But in a vengeful society driven by envy, instead of being aspirational to support those reducing pressure, we do the opposite so everyone is reduced to common levels of misery.

That is why successive govts can’t fix this mess, the electorate need a bogey man to blame & punish for the electorates’ failures instead of resolving and aspiring to do better and be like those more successful.

Even the little bit of pressure valve release of putting overflow NHS patients to the private sector is vigorously criticised by the clueless, who have never worked a senior mgmt role that involves managing run cost vs capacity planning.
In answer to the insurance question, it is highly highly unlikely that UK private insurance will cover CHRONIC conditions that require years of lifelong continuous monitoring & treatment. UK insurers are only geared up for funding diagnosis and acute treatment, ie it flares up, they diagnose , treat and it goes away, your premiums go up, and a few years later it comes back.. repeat cycle including jacked up premiums. In the U.S. the model is different as everyone employed has to be on private med insurance, so the insured funding pool is much larger, ie can take on NHS’ chronic healthcare role.

So in short, your insurer might help you pay for the consultant to diagnose & confirm which medication works, but not its ongoing monitoring & application, and biologics need very strict monitoring (blood tests etc). That ongoing requirement is usually written up, by the private consultant, sent to your GP who then uses that to refer to & advise the NHS rheumy, who will likely re-do the same confirmation & testing and if confirmed, will put you on the drug if it’s on the NHS.

It’s frustrating, but it’s we the electorate that vote for govts that dumb down education & critical thinking, instead helping us shoot ourselves in the foot… or stub our arthritic toe! @Trish9556

I have heard a certain helium filled mylar balloon hammer can help vent frustration with the mess, but I don’t know where to get one… I’ll ask Trish!

Trish9556

@Arthuritis

A couple of choices for you with an extra heavy one for those really frustraing times!

Trish9556

@Arthuritis

My recent hammer of choice!