Mich. bill seeks equal health coverage of cancer drugs
Lansing — Cancer patients and survivors are lobbying lawmakers to make Michigan the latest in a long line of states to require equal insurance coverage of chemotherapy regardless of whether the drugs are given by needle or taken orally.
The push addresses the tendency for chemo pills to cost patients much more out of pocket, both because they are more expensive and because health insurers cover them differently than intravenous chemo.
Amy Harvey, a 43-year-old mother from West Bloomfield who has had ovarian cancer for nearly seven years, said it cost her $3,100 for a two-week supply of a pill, Lynparza, because she had not met her deductible. While her doctor ultimately decided the drug was not a good match, she said it has been a “miracle” for other women who should not face financial constraints.
“As a cancer patient, you have plenty of things to worry about and stress over — life-altering decisions. Being able to afford your medication should not be one of them,” Harvey said.
The state Senate this month voted 36-1 for a bill to ensure that insurance coverage of oral anti-cancer medicines is not more financially restrictive than intravenously or injected medications. It would apply to deductibles, co-pays, coinsurance, other out-of-pocket expenses, annual limits and aggregate lifetime caps.
The legislation is aimed at combating how IV chemo treatments are covered like office visits under a policy’s medical benefit — which can mean flat, lower co-pays for patients — while oral chemo covered under a pharmacy benefit can bring much higher cost-sharing, especially for new drugs whose annual price can exceed $100,000.
Supporters say Michigan must adapt not only because the pills are becoming more prevalent but because they are more convenient, saving long trips to health care facilities for IV drips and affording patients more time at work and with family.
“A lot of times the oral is the only or is the best possible medication to use for a certain type of cancer. I want to make sure everybody can afford and have the ability to use the best possible cancer drug that they can,” said Republican Sen. Goeff Hansen of Hart, the bill sponsor who lost a son to cancer four years ago.
The legislation will next be considered in the House, where Insurance Committee Chairman Tom Leonard does not expect his committee to take up the bill before legislators break for the summer in mid-June. He said he has begun speaking with interest groups that support and oppose the measure, and he plans to meet with a cancer survivor this coming week.
He called it a “very complicated and complex issue” that requires additional study in the GOP-led chamber.
“I want to dive into this and make certain that we’re actually solving a problem, if you will, and also I’ve got serious concerns about the way that this could drive up health care costs,” said the DeWitt Township Republican.
A national coalition of cancer organizations says 40 states have enacted chemo parity laws, all in the last seven years. Alaska is expected to soon become the 41st.
Michigan’s legislation cleared the Republican-controlled Senate despite opposition from the insurance industry, including Blue Cross Blue Shield, and business groups such as the state Chamber of Commerce.
The Michigan Association of Health Plans says 3.4 million state residents, or roughly a third, could potentially face higher premiums as a result of the bill. (The state cannot regulate Medicare or self-funded employer plans that cover millions of other people in Michigan.)
Opponents say the parity bill is a “Band-Aid” that would not address the underlying issue: skyrocketing specialty drug costs that are forcing employers to boost premiums, co-pays and deductibles. They warn against interfering in private contracts and setting a precedent that could extend to treating diseases such as rheumatoid arthritis.
“The costs don’t go away. They just get shared differently,” Scott Lyon, senior vice president for the Small Business Association of Michigan, told senators at a January committee hearing. He said oral and IV chemo drugs “aren’t the same.”
“What we’re really getting at here is a matter of convenience, and that convenience comes with a pretty high cost,” said Lyon, who noted that the federal health care law sets yearly out-of-pocket maximum costs.
Reducing co-pays and other costs for cancer patients on oral medications would lead to a small increase in overall insurance costs, according to the nonpartisan Senate Fiscal Agency.
“Given the limited range of medications affected by this legislation relative to the overall cost of pharmaceuticals and health care in general, the cost increase would be nominal,” the agency said in April.
As the debate moves across the Capitol, backers of the legislation hope to avoid what happened in the 2011-12 session, when the Senate unanimously passed a similar bill only to see it die in the House. Harvey, who was diagnosed with stage 3c ovarian cancer in 2009, recently spent a day in her wheelchair in Lansing meeting with lawmakers with dozens of other advocates.
One was 54-year-old ovarian cancer survivor Michelle Shepherd of Rochester. Ovarian cancer recurs in 80 percent of cases, she said, and doctors must be able to try new drugs.
“If you have to eliminate things because of cost, you’re eliminating options to save your life,” Shepherd said.
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