Column: Allow new cancer treatments

Jerome Seid

A study published in JAMA Oncology last month supports the case for the lawmakers to enact patient-centered legislation to increase access to new forms of cancer treatment.

At issue are new, more easily-administered cancer medicines that can lead to better patient health outcomes, while potentially saving money for patients and health systems in the long run. These new treatments are oral medications and are alternatives to traditional chemotherapy typically administered in a doctor’s office through an intravenous line which is sometimes implanted.

Unfortunately, Michigan is one of seven states remaining in the U.S. that has failed to pass legislation to enhance patient access to these new medical treatments.

Because of legislative inaction, many patients face high out of pocket costs for these new cutting-edge cancer treatments. Many insurers force patients to pay more to access these 21st-century medical solutions than they do traditional IV chemotherapy. Current law permits this situation, and because these antiquated benefit designs do not reflect current clinical science, patients are faced with a conundrum with few simple solutions.

However, new findings show there are reforms that work to save money for patients, at no increased costs to insurers. The JAMA study explored the use of oral drugs for treating cancer, out-of-pocket costs associated with those treatments, and total health plan spending.

The study reviewed claims associated with consumers living in one of 16 states that enacted oral parity between 2008 and 2012. The study showed that following enactment of oral parity in these states:

■Most patients experienced a decrease in out-of-pockets costs for orally-administered cancer treatments.

■The number of prescriptions with $0 copays increased from 15 percent to 53 percent after passage of the law.

■There was no evidence that health plan spending increased after these states changed their laws.

Just 10 percent of consumers experienced any cost increase after the change. The study notes this group of patients was already experiencing higher out-of-pocket costs than the other 90 percent of consumers in the study. In the end, the study’s findings demonstrated a majority of patients benefited from these laws.

These findings underscore the need for legislation to create stronger out of pocket protections for patients in Michigan. It is unconscionable to, in essence, block access to the treatments patients need to live longer, more productive lives by permitting current laws to remain intact. This is especially true considering the latest JAMA data revealing insurers would experience no increase in costs as a result of the change.

The state Senate recently passed legislation, currently pending in the House, that would help achieve greater equity in how a plan’s medical and pharmacy benefits treat cost-sharing for oral oncology medications. The precise impact of this change will vary based on a patient’s individual benefit design, however the vast majority of patients will have their financial burdens lessened if the JAMA data as presented holds true .

Passage of these laws has coincided with a period of change in the health insurance market, especially as it relates to state-regulated plans. More than ever, patients are being required to shoulder a greater portion of the cost of care. Add the cost of out-of-pocket payments for urgently-needed cancer treatments, and the obstacles to care are enormous.

It is long past time the Legislature pass legislation to help all Michigan patients manage the out of pocket costs associated with their cancer treatments, and in accordance with the growing body of oncology literature which supports use of these tremendous advances.

Jerome Seid, MD, FACP is president of the Michigan Society of Hematology and Oncology.