Law would level the playing field for chemotherapy pills

Two bills progressing through the General Assembly may give cancer patients greater access to lifesaving cancer treatments.

March 3, 2012; 9:20 AM • by RVANews staff

From Capital News Service, Sherese A. Gore

Two bills progressing through the General Assembly may give cancer patients greater access to lifesaving cancer treatments.

House Bill 1273, sponsored by Delegate Christopher Peace, R-Mechanicsville, and Senate Bill 450, sponsored by Sen. Jill Holtzman Vogel, R-Winchester, seek to reduce the high cost of oral chemotherapy medications.

The legislation would require health insurers to enact cost-sharing criteria for both oral medications and intravenous treatments that would be “consistently applied within the same plan.”

The Senate overwhelmingly approved HB 1273 on Friday. It had passed the House unanimously on February 14th. Both chambers of the General Assembly unanimously passed SB 450 in late February.

Oral chemotherapy medication can cost as much as $80,000 a year. Many health plans treat such medication as a pharmacy benefit with substantially higher co-payments than would be required if the same drugs were administered intravenously in a hospital setting.

“What we are trying to say with this bill is to level the playing field,” Peace said.

Cindy Jones of Virginia Beach has spent more than a decade battling both cancer and mounting medical bills. In 2007, she began taking oral chemotherapy medication for treatment of colon cancer after intravenous treatments failed.

“It is the only thing that is keeping my cancer under control,” Jones said.

Orally administrated drugs have several benefits: They can cause less nausea, anemia, and hair loss typically associated with chemotherapy. In addition, a patient can self-administer the medication at home.

But those advantages are often outweighed by the high cost of the oral medication.

The $464 Jones contributed towards her health plan’s co-pay soon became a looming debt.

Dr. John Roberts, associate director for clinical research at Virginia Commonwealth University’s Massey Cancer Center, is well aware of the financial concerns of patients.

“In the situation where the only way that the medication is available is as a pill, then basically if the patient can pay the co-pay of $1,000 a month, then they can get it,” Roberts said. “If they can’t pay the co-pay, then they can’t get the medication.”

Health insurance companies argue that changes to the current system will ultimately drive up prices for everyone.

“The question is, where is the cost-share going to go?” asked Doug Grey, executive director of Virginia Association of Health Plans. “You either make the rest of the people who are getting it at an affordable level pay a little bit more, [or] put it in the health insurance premium and make everyone who buys the health insurance policy pay a little more.”

For now, a grant made possible by the Hampton-based Patient Advocate Foundation, a nonprofit organization that helps people with health care costs, enables Jones to continue receiving the drug.

If Gov. Bob McDonnell signs the legislation, Virginia will join 15 other states that have similar laws.

“We feel really good about where we are,” Peace said. “We won’t make it any harder than it already is when you’re fighting cancer.”

Photo by: erix!