Mich. Senate OKs equal coverage of oral cancer drugs
Lansing — Michigan would become the 44th state to require equal insurance coverage of chemotherapy regardless of whether the drugs are given by needle or taken orally under a bill the Senate overwhelmingly approved Wednesday.
The legislation will next be considered by the House, where a similar measure died last year in a committee that was led by lawmaker who has since become House speaker.
The bill 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 IV chemo. Starting in 2019, the legislation would ensure that insurance coverage of oral anti-cancer medicines is not more financially restrictive than intravenously or injected medications.
There could be no separate cost-sharing requirements applied only to oral drugs.
“It will make it so you can afford the chemo that your doctor says is best for you, whether it’s oral or whether it’s IV,” said the bill sponsor, Republican Sen. Goeff Hansen of Hart.
The measure, he said, is aimed at combating how IV chemo treatments are covered like office visits under an insurance policy’s medical benefit. That can mean flat, lower co-pays 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. Oral chemo is the best treatment for some cancers, he said.
The bill won approval 36-1 in the GOP-led chamber and is supported by the American Cancer Society Cancer Action Network. It is opposed by health insurers, which contend that government “price-fixing” would not address underlying skyrocketing specialty drug costs. Business groups are concerned it would make health insurance more expensive.
The nonpartisan Senate Fiscal Agency says the cost increase would be nominal.
Hansen said he is “cautiously optimistic” about the measure’s chances in the Republican-controlled House even though it stalled in 2016 in the House Insurance Committee, which was led at the time by now-Speaker Tom Leonard. The bill would pass if a vote is allowed, Hansen said.
“Forty-three other states have done it, so it’s not like it’s a one-off,” he said.
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