Raewyn Whitelaw has cancer. She is in remission, and there is a drug
that can keep her in remission longer – but the public health system does not
fund that drug.
Her health insurer will, right?
Wrong.
Southern Cross Healthcare won't. Their excuse - the
public health system does not fund the drug. But if it did, she would not need
health insurance.
Ms Whitelaw's life has been marked by
one milestone after another, including making it to her daughter's wedding six
months after being diagnosed with cancer in her lymphatic
system.
"Once I started my chemo, and I knew that the
wedding was coming up, I felt that I had a purpose so I carried on," she
says.
Then came the birth of her grandson a month
later.
"I think you just look at them and think, really
you've got to be there for them, don't ya."
She first
suspected something was wrong when she found a lump in her
neck.
"I had a biopsy done on it, and it changed my whole
life that day, you know," says Ms Whitelaw.
She went
through five difficult months of chemotherapy.
"Pretty
traumatic. I lost lots of weight and I dropped down to 45 kilos, which was
fairly thin."
Once she finished chemo, her doctor advised
maintenance treatment with a drug called Rituximab to improve her chances of
keeping the cancer away. But it is not publicly funded in New Zealand if you
have only had cancer once, so she had to go to Australia for the first bout of
private treatment.
"The specialist in Melbourne said it's
just a wonderful drug, and he said, 'We can contain your cancer like we can
contain somebody with diabetes for a long time.' So for me, that gave me a
positive outlook on life because I certainly didn't have
one."
The rest of her Rituximab treatment was at a private
clinic in Palmerston North, costing $4000 every three months. So far she has
paid around $35,000 for treatment.
Ms Whitelaw went to her
health insurer, Southern Cross, to cover the private
treatment.
"Non-Hodgkins lymphoma is not curable, but this
drug would make it containable and give me a reasonable life for a few more
years," says Ms Whitelaw. "That's why I took insurance out - I thought I'm safe,
I've got this insurance."
Despite her doctor recommending
Rituximab, Southern Cross rejected her request for
cover.
In a statement, it says it "relies on Pharmac
guidelines to guide which drugs we fund", and believes "the public health system
should remain New Zealanders' first port of call for cancer
treatment".
"They're prepared to take the money off me all
these years, but when I need it they're not there to help me," says Ms
Whitelaw.
Her lawyer Helen Monckton says surely the point
of health insurance is for instances like this.
"I would
have thought that Southern Cross should be taking up the slack because that's
why you have a health policy," says Ms Monckton.
Ms
Whitelaw has had health cover for 15 years, and she made sure it included cover
for cancer drugs. She has paid Southern Cross around $18,000 dollars over the
years.
"I just think it's a complete waste of money, being
with them," she says. "They have helped me in the past on the odd occasions that
I've needed them, but when you really need them the most, that's when they've
let me down."
Her oncologist at Waikato Hospital even
wrote to Southern Cross appealing for them to cover her. In a letter, Dr Kuper
said Ms Whitelaw got health insurance to cover shortfalls like this in the
public health service, and it would be remiss of them not to cover
her.
She says Rituximab is standard care across the world,
as it increases the chances of survival.
"I took insurance
out to cover myself in later years and now I find it's Pharmac that it seems
I've taken my insurance out with, not Southern Cross," says Ms
Whitelaw.
In a case of very bad timing, Pharmac will
tomorrow (July 1) start funding Rituximab for people with non-Hodgkins lymphoma
for the first time - people just like Ms Whitelaw.
So once
again, she has slipped through the net.
"Once I started
the Rituximab, I really did have a really positive outlook on life, and I've
never looked back really since then," says Ms Whitelaw. "I just feel so well and
I just do everything I can do and I treat every day as a new day, 'cause you
just never know when you're never gonna be here."
But Ms
Whitelaw has personally paid the $35,000 bill to get her life
back.