NHS Cancer Drug Fund Denied: How to Appeal in UK

The Cancer Drugs Fund (CDF) was established in England to give cancer patients faster access to promising new drugs while NICE conducts its full appraisal process. But not every cancer drug is on the CDF list — and even when a drug is available through the CDF, access is not guaranteed for every patient. If your CDF application has been denied, or if your oncologist has been unable to access a drug for you, this guide explains the system and how to challenge a refusal.

How the Cancer Drugs Fund Works

The CDF is a managed access fund operated by NHS England. It allows cancer drugs to be available to patients in England before NICE has completed its full cost-effectiveness appraisal. Drugs enter the CDF through a NICE managed access agreement and are available to patients who meet specific clinical criteria (the "population" defined by NICE).

If a drug has received full NICE approval, NHS Integrated Care Boards (ICBs) are legally required to fund it within 90 days of approval. Refusal of a NICE-approved drug is unlawful, and this is a different situation from CDF access or Individual Funding Request (IFR) denials.

The situations where patients most commonly face denials are:

1. The drug is on the CDF but the patient does not meet the clinical criteria. NICE sets specific criteria (performance status, prior treatment lines, tumour characteristics). If you fall outside those criteria, your oncologist may be unable to access the drug through the standard pathway.

2. The drug is not on the CDF or NICE-approved list. The drug exists and your oncologist believes it is the best option for you, but it has not yet been evaluated by NICE.

3. The drug has been denied via Individual Funding Request. Your oncologist applied for exceptional funding through your ICB and was refused.

Individual Funding Requests (IFRs)

When a drug is not routinely available (not on the CDF, not NICE-approved, or not meeting CDF criteria), a clinician can make an Individual Funding Request to the relevant Integrated Care Board. An IFR asks the ICB to fund treatment for a specific patient as an exceptional case.

ICBs assess IFRs against their policies, which typically require the patient to demonstrate exceptionality — that their clinical circumstances are materially different from other patients with the same condition, such that the drug is likely to provide greater benefit for them than for the typical patient.

This is a high bar, and many IFRs are denied.

Challenging an IFR Denial

Step 1: Understand the reason. The ICB must provide a written decision explaining why the IFR was refused. Common reasons include: the patient does not meet the exceptionality test, insufficient clinical evidence, or the drug is not cost-effective. Request the full decision letter if you have not received one.

Step 2: Ask your oncologist to strengthen the application. An IFR is most likely to succeed when supported by detailed clinical evidence specific to your case — your tumour's specific characteristics (biomarkers, mutations), your response or failure to respond to standard treatments, and published evidence or case reports showing benefit in patients like you. If the first IFR was rejected, your oncologist can submit a revised application.

Step 3: Request an IFR panel review. ICBs have an IFR Panel or Exceptions Committee that reviews applications. Ask specifically to have the decision reviewed by the panel if it was refused at an administrative level.

Step 4: Appeal to the ICB's review process. Most ICBs have a formal appeal mechanism for IFR decisions. The appeal is heard by an independent panel, which may include clinicians not involved in the original decision. Your oncologist, a patient advocate, or a legal representative can attend.

Step 5: NHS England oversight. If the ICB appeal process does not resolve the matter, NHS England has oversight responsibilities. Complaints can be made to NHS England's Customer Contact Centre.

If Your Drug Is NICE-Approved but Being Denied

If NICE has issued positive guidance on a drug and your ICB is not funding it, this is potentially unlawful. The ICB has a statutory duty to fund NICE-approved treatments within 90 days of approval.

In this situation:

• Contact your ICB's complaints team in writing.
• If the ICB does not resolve the matter, the Parliamentary and Health Service Ombudsman (PHSO) can investigate NHS bodies (not just private insurers).
• NHS Resolution and Healthwatch can assist with signposting.
• In exceptional cases, judicial review has been used to challenge ICB funding decisions.

Private Health Insurance and Cancer Drugs

If you have private medical insurance alongside NHS access, your PMI policy may cover cancer drugs that the NHS does not fund. However, PMI cancer drug cover is subject to its own limitations:

• Policies typically cover drugs approved for marketing authorisation (by the MHRA) for your specific indication.
• Some policies cover cancer drugs only if they are NICE-recommended.
• Policies with cancer benefit caps may reach their limit before treatment is complete.

If your PMI insurer has denied a cancer drug claim, the FOS is the appropriate route (see our other UK guides).

Practical Support Resources

• Macmillan Cancer Support — provides patient advocacy and can assist with understanding IFR processes.
• Rarer Cancers Foundation — specialises in IFR advocacy for patients with less common cancers.
• Cancer Research UK — publishes information on drug approvals and CDF decisions.
• NHS England's Cancer Drugs Fund website — lists all current CDF drugs and their clinical criteria.

Key Points to Remember

• A CDF denial is not necessarily permanent. NICE re-evaluates drugs, and clinical criteria can change.
• An IFR denial can be appealed through the ICB's own processes.
• If a NICE-approved drug is being withheld, the ICB may be acting unlawfully.
• Your oncologist is your most important advocate. A detailed clinical letter specific to your case is the single most powerful piece of evidence in an IFR or appeal.

Navigating the CDF and IFR system is genuinely complex, but patients have successfully overturned denials at every stage of the process. Persistence, clinical evidence, and a well-structured appeal are the keys.

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Related Reading:

• How to Write an Insurance Appeal Letter
• What Is Medical Necessity?
• Internal vs External Insurance Appeal