August 22, 2014

Patients, doctor ask lawmakers for ‘parity’ between oral, IV chemotherapy coverage costs

Bills have been heard in the committees in the state House and Senate that would require insurance companies to charge patients the same out-of-pocket amount to cover oral chemotherapy as they would to cover intravenous chemotherapy.

Representative Sheila Solon (left) watches as Doctor Carl Freter testifies in favor of her legislation regarding oral chemotherapy (HB1327).  (photo courtesy; Tim Bommel, Missouri House Communications)

Representative Sheila Solon (left) watches as Doctor Carl Freter testifies in favor of her legislation regarding oral chemotherapy (HB1327). (photo courtesy; Tim Bommel, Missouri House Communications)

Insurance plans often treat oral chemotherapy as a pharmacy benefit but treat intravenous therapy as a medical benefit. This means patients generally pay more for oral than they would for intravenous.

Lawmakers have been told that makes it cost-prohibitive for some patients to get the pill form. Ellis Fischel Cancer Center Doctor Carl Freter says the pills are often much more effective and targeted at cancer cells.

“These oral chemotherapy drugs represent the newest, best approach to chemotherapy in almost every case,” says Freter. “They are targeted agents that specifically kill cancer cells because of some property the cancer cell has.”

Sponsor of the House legislation, Representative Sheila Solon (R-Blue Springs), says that means patients taking chemotherapy pills can often go on living their lives and even working, which is often not true for those taking the intravenous form.

“Many times the orals attack the cancer cells themselves, so that’s why you’re not getting as sick,” says Solon. “It’s targeted, it’s going after the cancer and that’s why you have less side effects. Patients don’t lose their hair, they don’t get as sick.”

The panels heard from some patients who tried to make lawmakers understand what a difference it makes not to have the side effects of intravenous chemotherapy. Ross Nichols, a lobbyist for the Missouri Trucking Association, used oral chemotherapy to fight a brain tumor.

“That made my life very normal,” said Nichols. “When something like this happens to you, the fight is to try and get back to normal. That’s all you’re trying to do. I have to kids. That’s all I ever tried to do is just be regular and normal.”

St. Louis resident JoAnn Shaw has survived cancer four times, but told lawmakers what intravenous chemotherapy has done to her body.

“I have brittle bone disease so if I fall that can be a disaster, I have permanent hair loss so as Ross knows he has more hair than I do … I have compromised lungs,” Shaw said. “The effects of IV chemo are devastating.”

Two bills in the Senate and one in the House have not been voted on by their respective committees.  No one offered testimony against the legislation. 

Anthem Blue Cross/Blue Shield lobbyist David Smith encouraged lawmakers to look at laws passed in other states that might be less costly to insurance companies.

Listen to the testimony of JoAnn Shaw (5:06) and Ross Nichols (4:11) below: