Health minister Ben Bradshaw has said the dilemma of whether to allow co-payments will never be resolved but that a compromise may be found in adjusting the way drug effectiveness is measured.
Speaking at a fringe event hosted by the King's Fund, Mr Bradshaw acknowledged the tension between the desires for equality and for fair treatment of those who wanted to spend their own money on drugs that were not deemed cost-effective.
Referring to the national clinical director for cancer, who has been charged with reviewing the government's policy on top-ups, Mr Bradshaw said: "I hope Mike Richards will come up with something that is quite imaginative that won't open the floodgates."
The National Institute for Health and Clinical Excellence has been accused of making unfair decisions about which drugs the health service can pay for. But Mr Bradshaw defended the organisation, saying its drug evaluations were used internationally.
But he added: "Yes, they could work faster... and maybe we could give greater value to those last weeks of life."
Quality of life
This latter point would involve NICE amending the formulas it uses to calculate the quality-adjusted life years that a particular drug can bring a patient so that they recognise the increased value patients give to their last few weeks of life. That could have the effect of making more of the drugs involved in the debate available on the NHS.
But British Medical Association consultants committee chairman Jonathan Fielden did not agree with sanctioning top-ups. Instead, he suggested changing the rules around patenting drugs, to reduce their cost.
"It takes 15-20 years to develop them but the companies have to recoup their costs within just a few years," Dr Fielden said.