Cancer Care
An overview of the cancer care benefit and how we will support you, different types of treatment, and examples to help you understand different cancer claims.
Important information about the Cancer Care benefit
Please read the following information in conjunction with your Guide, Benefit Schedule and Certificate of Registration (or Certificate of Participation). Together these documents contain the terms and conditions of your Policy/Company Scheme, including the details of any exclusions, benefit limits and restrictions on hospital choice that may apply.
The Cancer Care benefit must be included as standard or selected as an optional extra under your Policy/Company Scheme. Any Shared Responsibility (co-payment)/excess or maximum annual limits apply to claims.
Please remember that all claims must be pre-authorised; WPA will contact the specialist in charge of your treatment to obtain a full treatment plan.
Any cancer treatment must be endorsed by your specialist's Multi-Disciplinary Team in accordance with best practice guidelines from NHS England or equivalent in the devolved nations.
Depending on the type of treatment prescribed by your specialist and any applicable terms and conditions, you have a choice of where you receive treatment: as a private in-patient; day-patient; out-patient; or at home. If your Policy/Company Scheme includes benefit for NHS Hospital Cash Benefit - Cancer then you may choose to have your treatment as an NHS patient and claim the cash benefit instead.
Learn more about the different types of cancer treatment available
Cancer support
Any of our members who are diagnosed with cancer will be supported by our Clinical Team, who are trained to manage a patient's care from both a medical and emotional perspective - making a real difference to the way an individual feels and providing much needed support during their cancer journey.
We have considerable experience in helping our members through challenging times and know that each individual requiring treatment will have differing needs. A diagnosis of cancer brings with it an understandable mixture of emotions and concerns for patients and their families. Our Clinical Team will be on hand to support you through your journey and will tailor their support to meet your individual needs. You can also find information in our Health insurance glossary to help you understand some of the terminology often used when you are making a claim.
There are different types of treatment for cancer and the information below may help to understand some of these:
Radiotherapy
Radiotherapy uses radiation, usually x-rays, to treat cancer. You might have radiotherapy from inside the body (internal radiotherapy) or external radiotherapy (from outside the body).
You may have radiotherapy to try to cure cancer and to reduce the chance of cancer coming back. Sometimes radiotherapy is given to relieve symptoms. Radiotherapy may be given by itself or with other treatments, such as chemotherapy or surgery.
Chemotherapy
Chemotherapy is drug treatment where medicine is used to kill cancer cells. There are many different types of chemotherapy medicine, but they all work in a similar way.
They stop cancer cells reproducing, which prevents them from growing and spreading in the body. It may be given to:
- cure cancer completely (curative chemotherapy)
- make other treatments more effective, for example, it can be combined with radiotherapy (chemoradiation) or used before surgery (neo-adjuvant chemotherapy)
- reduce the risk of the cancer coming back after radiotherapy or surgery (adjuvant chemotherapy)
- relieve symptoms if a cure is not possible (palliative chemotherapy)
Chemotherapy treatment may be given in different ways but most commonly via an intravenous tube, or as an oral medication.
Targeted Cancer Therapies
Targeted therapies are advanced chemotherapy drugs that find and attack cancer cells.
These drugs block the growth and spread of cancer by interfering with specific molecules (also referred to as “molecular targets”) that are involved in the growth, progression and spread of cancer. There are many different types of targeted cancer therapies such as monoclonal antibodies, cancer growth blockers, drugs that block cancer blood vessel growth, PARP inhibitors and immunotherapy.
Targeted cancer therapies may be given in different ways but most commonly via an intravenous infusion, or as an oral medication.
Advanced Therapy Medicinal Products (ATMPs)
Advanced therapy medicinal products (ATMPs) are medicines for human use that are based on genes, tissues or cells. They offer groundbreaking new opportunities for the treatment of cancer (and other non-cancer conditions).
Advanced Therapy Medicinal Products are either:
- A gene therapy medicinal product
- A somatic cell therapy medicinal product
- A tissue engineered product
Where your WPA policy/scheme includes benefit for ATMPs, we will only fund those drugs that appear on our list of approved ATMPs. It is important to check your policy/scheme offers cover for ATMPs and all treatment must be pre-authorised.
Important note: not all policies/schemes offer benefit for ATMPs.
IMPORTANT INFORMATION FOR YOU AND YOUR CLINICIANS
Any drug that does not appear on this list will not be funded under the terms of your scheme/policy.
Some policies/schemes do not fund ATMP treatment.
All treatment requests must be submitted for prior approval by WPA in advance. Treatment that commences without authorisation will not be approved.
For all treatment requests please call 01823 625260.
Last reviewed: 25/03/2026
| Reference | Generic name | Brand name | Licensed indication/s | WPA Approval requirements |
|---|---|---|---|---|
| AD01 | Talimogene laherparepvec (T VEC) | Imlygic | Treatment of adults with unresectable melanoma that is regionally or distantly metastatic (Stage IIIB, IIIC and IVM1a) with no bone, brain, lung or other visceral disease. | For cancer only and within MHRA license. A clinical Multi Disciplinary Team (MDT) authorisation is required. |
| AD02 | tisagenlecleucel | Kymriah | Paediatric and young adult patients up to 25 years of age with B-cell acute lymphoblastic leukaemia (ALL) that is refractory, in relapse post-transplant or in second or later relapse. AT001 hospital Multi-disciplinary team (MDT) Adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) after two or more lines of systemic therapy. | For cancer only and within MHRA license [or other UK equivalent] And NCCP panel review has approved along with any other relevant MDT authorisation. |
| AD03 | Autologous anti-CD19 - transduced CD3+ cells | Tecartus | Adult patients with relapsed or refractory mantle cell lymphoma after two or more lines of systemic therapy, one of which must have included a Bruton's tyrosine kinase (BTK) inhibitor. | For cancer only and within MHRA license [or other UK equivalent] And NCCP panel review has approved along with any other relevant MDT authorisation. |
| AD04 | axicabtagene ciloleucel | Yescarta | Adult patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) and primary mediastinal large B-cell lymphoma (PMBCL), after two or more lines of systemic therapy. | For cancer only and within MHRA license [or other UK equivalent] And NCCP panel review has approved along with any other relevant MDT authorisation. |
| AD05 | lisocabtagene maraleucel | Breyanzi | Treatment of adult patients with diffuse large B-cell lymphoma (DLBCL), high grade B-cell lymphoma (HGBCL), primary mediastinal large B-cell lymphoma (PMBCL) and follicular lymphoma grade 3B (FL3B), who relapsed within 12 months from completion of, or are refractory to, first-line chemoimmunotherapy. Treatment of adult patients with relapsed or refractory DLBCL, PMBCL and FL3B, after two or more lines of systemic therapy. | For cancer only and within MHRA license [or other UK equivalent] And NCCP panel review has approved along with any other relevant MDT authorisation. |
| AD06 | obecabtagene autoleucel | Aucatzyl | Treatment of patients aged 26 and over with B-cell acute lymphoblastic leukaemia (ALL) which has returned or was unresponsive to previous treatment. | For cancer only and within MHRA license [or other UK equivalent] And NCCP panel review has approved along with any other relevant MDT authorisation. |
Cancer claim examples
Please read the following information in conjunction with your Guide, Benefit Schedule and Certificate of Registration (or Certificate of Participation). Together these documents contain the terms and conditions of your Policy/Company Scheme, including the details of any exclusions, benefit limits and restrictions on hospital choice that may apply.
The Cancer Care benefit must be included as standard or selected as an optional extra under your Policy/Company Scheme. Any Shared Responsibility (co-payment)/excess or maximum annual limits apply to claims.
Please remember that all claims must be pre-authorised; WPA will contact the specialist in charge of your treatment to obtain a full treatment plan.
Any cancer treatment must be endorsed by your specialist's Multi-Disciplinary Team in accordance with best practice guidelines from NHS England or equivalent in the devolved nations.
Depending on the type of treatment prescribed by your specialist and any applicable terms and conditions, you have a choice of where you receive treatment: as a private in-patient; day-patient; out-patient; or at home. If your Policy/Company Scheme includes benefit for NHS Hospital Cash Benefit - Cancer then you may choose to have your treatment as an NHS patient and claim the cash benefit instead.
Please note that the example questions are set by industry standards and are not based on any individual customer scenario.
Customer A has been with WPA for 5 years when they are diagnosed with breast cancer.
Following discussion with their specialist Customer A decides:
- To have the tumour removed by surgery. As well as removing the tumour, treatment will include reconstructive surgery.
- To undergo a course of radiotherapy and chemotherapy.
- To take hormone therapy tablets for several years after the chemotherapy has finished.
Is this treatment eligible for benefit?
WPA would provide benefit for surgery, radiotherapy and chemotherapy provided that these are active established treatments, within the UK licence and given with curative intent. Benefit is available for breast reconstruction provided it takes place within five years. We would need a treatment plan setting out the procedures and the timescales. Follow up treatment by the specialist would be covered (subject to any timescales that may apply). Hormone therapy tablets prescribed by a GP would not be covered.
Note: Adjuvant chemotherapy will be covered for up to 12 months.
During a course of chemotherapy Customer A suffers from anaemia. Their resistance to infection is also greatly reduced.
The specialist:
- Admits Customer A to hospital for a blood transfusion to treat their anaemia.
- Prescribes a course of injections to boost their immune system.
Is this treatment eligible for benefit?
Yes, as long as it is medically necessary as part of active cancer treatment [and the injection(s) are administered in line with their UK licence].
Please note that emergency admissions to either a private hospital or critical care unit are not covered.
Despite the injections to boost their immune system, Customer A develops an infection and is admitted to hospital for a course of intravenous antibiotics.
Is this treatment eligible for benefit?
Yes, their admission would be covered and they can choose where they receive treatment. Based on what the specialist recommends, Customer A could be treated in hospital as an in-patient, day-patient or out-patient, or at home.
Please note that emergency admissions to either a private hospital or critical care unit are not covered. If they choose to have treatment in an NHS hospital they could claim NHS Hospital Cash Benefit- Cancer.
6 years after Customer A's treatment finishes, the cancer returns. Unfortunately it has spread to other parts of their body. The specialist has recommended a treatment plan consisting of:
- A course of 6 cycles of chemotherapy aimed at destroying cancer cells to be given over the next 6 months.
- Monthly infusions of a drug to help protect the bones against pain and fracture. This infusion is to be given for as long as it is working.
- Weekly infusions of a drug to suppress the growth of the cancer. These infusions are to be given for as long as they are working.
Is this treatment eligible for benefit?
Firstly, we would need their specialist to send us a detailed treatment plan including the type of drugs to be used. Standard licensed chemotherapy is covered in full. The drug infusions are known as Targeted Cancer Therapies and benefit for treatment with them is available providing they are:
- Being used within the UK licence;
- NOT available to them on the NHS;
Drugs given to maintain remission of cancer, where the drugs are used to maintain good health and there are no symptoms, would not be covered.
Note: Targeted Cancer Therapies for blood cancers will be covered for up to 24 months.
Customer B has been with WPA for seven years when they are diagnosed with cancer. Following discussion with their specialist they decide to undergo a course of high dose chemotherapy, followed by a stem cell transplant (sometimes called a 'bone marrow' transplant).
Is this treatment eligible for benefit?
Yes. [This treatment must be pre-authorised]. We will pay for one complete stem cell/bone marrow transplant per lifetime for each individual person insured by the Policy/Company Scheme if it is not available to them on the NHS and authorisation must be obtained and granted before the stem cell or bone marrow treatment starts. We reserve the right to ask for a second clinical opinion as to the evidence of efficacy of the proposed treatment for each particular case.
All costs related to a donor are not eligible.
When Customer B's treatment is finished, their specialist tells them that their cancer is in remission. The specialist would like Customer B to have regular check-ups for the next five years to see whether the cancer returns.
Is this treatment eligible for benefit?
Follow up check-ups would be covered (subject to any timescales that may apply).
Any drugs given to maintain remission of cancer, where the drugs are used to maintain good health and there are no symptoms, would not be covered.
Customer C has been diagnosed with cancer. Their Policy/Company Scheme has an annual benefit limit and they decide to commence private treatment.
Is this treatment eligible for benefit?
If the Policy/Company Scheme has a maximum annual benefit limit then this will apply. Otherwise, there are no monetary benefit limits on cancer care as a private patient. If a single aspect of treatment falls outside the benefit provided by the Policy/Company Scheme and they need to split their cancer care i.e. have some treatment on the NHS while continuing to have other treatment privately, we will work with Customer C and their specialist to arrange a timely and smooth transition into NHS care, ensuring no clinical detriment to them or their ongoing treatment.
Customer D would like to be admitted to a hospice for care aimed solely at relieving symptoms as no further treatment is appropriate.
Is this treatment eligible for benefit?
We do not provide benefit for end of life care i.e. treatment that concentrates on controlling pain and other symptoms when the patient is near or approaching the end of life and active treatment for the causative disease is no longer considered effective or appropriate. Where a patient is admitted to a hospice we may make a donation to the hospice. If the patient chooses to have this care at home, we may make a donation to the supporting charity e.g. Macmillan Cancer Support.