Cancer drugs should be treated equally
DR. DON BENSON
Imagine you had cancer. Now imagine that your doctor explained that, instead of taking traditional chemotherapy by vein, you could take a new and more effective pill with fewer side effects. However, while the intravenous chemotherapy may cost you a few hundred dollars a month, the pill form of treatment may cost you hundreds of dollars a day, or more.
Why such a vast gap? Insurance companies cover each option quite differently.
Traditional IV chemotherapy is covered under a patient’s hospital-care benefit, which generally requires the patient to contribute a relatively small co-pay to receive the treatment. Cancer treatments that come in pill form are considered prescription drugs and are covered through a patient’s pharmacy benefit. As a result, many patients are required to pay very high out-of-pocket costs to receive their prescribed medication.
It’s disturbing to think that this inequity in coverage may keep patients from receiving the most-effective treatment available for their cancer.
- Novel oral cancer treatments have transformed some forms of cancer from certain death sentences into manageable chronic conditions (not unlike diabetes or high blood pressure). However, as with treatment of those maladies, patients often must take the cancer pills for extended periods of time in order to live with — rather than die from — their disease.
Oral anti-cancer medications represent a major step forward in disease management and are a big part of the future of cancer treatment. More than a quarter of promising anti-cancer drugs in development are pills. Because most insurance companies have not updated their policies voluntarily, it is time for our legislators to require insurance companies to revise coverage plans for chemotherapy drugs.
A bill in the Ohio General Assembly, Senate Bill 194, would create equity in patients’ out-of-pocket costs for oral anti-cancer treatments, ensuring that patients have ready access to the medication their physician deems most appropriate. The bill provides that health plans’ coverage for pill-based cancer treatments may not be less favorable than the coverage for IV chemotherapies.
As an oncologist and cancer researcher at the Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, I know how important this proposed legislation is for cancer patients seeking treatment here, and elsewhere around the state. That’s why OSUCCC–James leaders have teamed up with other statewide advocates to push for the passage of this bill.
Senate Bill 194 also would end a dangerous drug-dispensing practice known as “brown bagging,” which occurs when an insurer contract requires a patient to receive medications from a mail-order pharmacy via a commercial carrier.
Hospitals and clinics have strict procedures in place to ensure safe handling and administration of these medications. Patients may not know the dangers of mishandling these drugs, nor the proper ways to protect themselves.
When patients bring to the hospital medications that were dropped off on their doorstep, oncologists cannot tell whether the chemotherapy drugs have been compromised, rendering them hazardous. It would be safer to have an oncology-drug distributor directly deliver the chemotherapy drugs to oncologists at medical facilities.
Senate Bill 194 would modify the insurance companies’ delivery requirements, ensuring that drugs are ordered, delivered and administered more safely.
Our accelerating progress in cancer research, especially the availability of effective, targeted cancer therapies that come in pill form, needs to be matched by progress in our insurance system. The insurance industry must be required to remove cost discrepancies faced by patients between pill and IV forms of therapy, and to improve the safety of how anticancer medications are obtained and administered.
Senate Bill 194 is necessary to provide patients with cancer the kind of care they need and deserve. Ohio should join the 14 states that already have passed oral-chemotherapy equity statutes and should be the first state to pass legislation eliminating the practice of “brown bagging.” Please encourage our state legislators to pass Senate Bill 194.
Dr. Don Benson is assistant professor of medicine in the Division of Hematology at the Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.
(My Comment:
Not sure I really understand the problem with this excerpt from above: “Senate Bill 194 also would end a dangerous drug-dispensing practice known as “brown bagging,” which occurs when an insurer contract requires a patient to receive medications from a mail-order pharmacy via a commercial carrier.”
I have very frequently been doing just that for two reasons. It is convenient to me and saves me a trip out just for that. Additionally, it is cost saving to me. One generally uses this as a saving device as one can buy quarterly and pay less money. It’ s handled through the mail ( I have a safe box which takes a key and have never had a problem. The package is sealed as are the containers within the package. So what’s the problem?
What occurs to me is the need to enter your doctor’s one more time or every time you get medicine. That is an extra inconvenience and for some, going to be more expense. . . which no-one needs. Jan)
