Opinion: Anti-cancer pills should cost less

Jerome Seid

Cancer patients aren’t alone in their fight. Medical science and health care providers are every day developing newer, more targeted, and more effective treatments to defeat this horrible disease. Even better, many of the cutting edge treatments that work best can be given orally, allowing patients to avoid the intravenous chemotherapy we so often associate with cancer treatment.

Now, a group of lawmakers at the state Capital are working on a reform that would ensure Michigan patients have better access to these life-saving treatments, with lower out-of-pocket costs. The legislative battle over anti-cancer access has been brewing for years, but an earnest willingness from some key lawmakers to make this a reality has cancer patients more hopeful than ever.

Many of the new anti-cancer treatments are actually taken in the form of a pill. They target the cancer cells with pinpoint precision, and they protect the surrounding cells. Many IV chemotherapy side effects – the illness, the nausea, the hair loss, are for many a thing of the past.

"Michigan law allows insurance companies to extract higher out-of-pocket costs for chemotherapy treatments, if those treatments are taken by pill."

Just not in Michigan. While nearly every other state in the nation has embraced these new treatments, Michigan continues to lag behind. That’s because of a hiccup in state law that allows insurance companies to extract higher out-of-pocket costs from some cancer patients for chemotherapy treatments, if those treatments are taken orally – in the form of a pill.

Insurers regularly cover IV chemotherapy treatments and at a lower out-of-pocket cost to patients. They cover the patient’s physicians and the nurses and the techs at the hospital or treatment center. They cover facilities and the equipment and the time and the expense associated with delivering the IV medicine. In fact, adding all the ancillary fees and costs, IV chemotherapy might cost as much or more than oral treatment of the same disease.

Some insurers claim the push to align patients’ out-of-pocket expenses, regardless of what kind of chemotherapy they require, will raise their costs, but the evidence suggests otherwise.

A study published late last year in JAMA Oncology found absolutely no evidence that health plan spending increased in other states that were studied after they have enacted similar reforms. In other words, the move won’t even cost insurers. It will simply help patients.

Michigan lawmakers have been trying to tackle this hole in cancer treatment coverage for years. State Senator Goeff Hansen, R-Hart, introduced Senate Bill 492, which would ensure oral chemotherapy parity, and the bill passed the Senate with nearly unanimous bipartisan support. In the House, state Representative Daire Rendon, R-Lake City, introduced similar legislation – House Bill 5367 – but it was immediately referred to the House Insurance Committee where it never received a real hearing.

Hansen and Rendon have been powerful and articulate allies for cancer patients, and patient advocates couldn’t be more grateful for their continued leadership.

Now their bills have been transferred to a new committee, House Health Policy, chaired by Representative Henry Vaupel, R-Fowlerville.

As Representative Vaupel and his committee consider this important reform I encourage them to remember what this conversation is really all about. House Bill 5367 and Senate Bill 492, which are both before the committee, may make all the difference in the world for cancer patients in Michigan.

Jerome Seid, M.D., is former president of the Michigan Society of Hematology and Oncology.