Legislature considers future of chemo coverage

JEFFERSON CITY (AP) — JoAnn Shaw was first diagnosed with cancer at age 19. Then again at 25. And 37. And 53. Each time, she was treated with intravenous chemotherapy.

Today, she wears a wig, talks with a raspy voice and is in danger of losing sight in one eye — not because of the cancer, but because of the side effects of the treatment, she said.

“I am a walking result of four cancer diagnoses with traditional infusion therapy,” Shaw, 68 of St. Louis, told a Missouri Senate committee this past week. She added: “Although it saved me, it’s destroyed most of the other systems” in her body.

Shaw came to the Capitol in support of a newer and less physically draining way to treat cancer through chemotherapy pills that are swallowed like most other medicines.

Legislation pending before Missouri Senate and House committees would require insurance companies to charge patients the same out-of-pocket costs for chemotherapy pills as they do for chemotherapy treatments pumped directly into the bloodstream.

Patients currently often are charged more for oral chemotherapy, which is covered as a pharmacy benefit, than for intravenous therapy, which is covered as a medical benefit requiring only a routine co-payment for an office visit.

Twenty-seven states and the District of Columbia already have enacted laws requiring equal coverage for oral and intravenous chemotherapy treatments. The trend began in 2008 in Oregon and continued last year with new laws in more than a half dozen states.

Ruth Pirch, of Oak Grove, said her husband was diagnosed with cancer in his lungs last spring, marking his fourth cancer diagnosis since 1990. She said an oncologist recommended an oral chemotherapy drug that would have cost $6,000 to $7,000 every six weeks. But they decided that was too expensive on a long-term basis, so her husband has been receiving intravenous treatments covered by Medicare and private insurance.

“I feel like I’m speaking for a lot of families who are concerned and have to make this decision on what they’re going to do,” Pirch said. “I just think that we need to have parity.”

An actuarial study by Overland Park, Kan.-based Lewis and Ellis Inc. found that Missouri health insurance premiums would rise by an average of 57 cents per month if a law were enacted requiring equal coverage for oral chemotherapy. That equates to a roughly $12 million impact statewide, said David Smith, a lobbyist for Anthem Blue Cross Blue Shield of Missouri.

The Missouri legislation would prohibit health insurers from requiring higher co-payments and deductibles for oral chemotherapy than for intravenous treatments. It also would prohibit insurers from increasing the patient payments required for intravenous chemotherapy in order to make them equal to higher oral chemotherapy costs.

No one testified against the bill at a Senate insurance committee hearing. But Smith suggested the legislation could be changed to lower the costs to insurers. Smith pointed to a Kansas law, which lacks the prohibition on the costs of intravenous chemotherapy rising to create parity with oral treatments. He also cited a California law taking effect in 2015 that sets a maximum $200 co-payment for each chemotherapy pill prescription.

About half of the most common forms of cancer now can be treated with oral chemotherapy, said Dr. Carl Freter, chief of hematology and oncology at the Ellis Fischel Cancer Center at the University of Missouri-Columbia. The pills not only are more convenient for patients but also typically lack side effects such as vomiting and hair loss that accompany intravenous chemotherapy.

“This is really the future of chemotherapy,” Freter said. He added: “Oral therapy simplifies cancer care — it simplifies it for patients, it simplifies it for physicians, nurses and everybody taking care of cancer patients.”

Shaw said her life has been far from simple as a cancer patient undergoing multiple rounds of intravenous chemotherapy.

“Infusion therapy worked, obviously — I’m here. But the effects,” she said without finishing the sentence. “We know that there’s not the same long-term effects with the oral chemotherapy.”

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