Here is the second half of the article I ran yesterday, Gaps in insurance policies make oral drugs too pricey for some cancer patients:
To Brian Durie, a hematologist-oncologist at Cedars-Sinai Hospital in Los Angeles who specializes in the treatment of multiple myeloma, the debate about cost obscures a stark reality. “Myeloma patients need access to all the drugs,” he said. “They’ve got two choices: an oral drug or death.” Some myeloma patients need an oral drug called Revlimid, which can cost more than $7,000 per month, after an IV drug stops working. The pill enables some patients to continue working and to live normal lives.
“Some of the saddest stories are patients who say, ‘I don’t want to die and leave my family with a bundle of debt,’ ” Durie said. “These are people with a lethal disease, and it is so, so stressful” for them to also wrestle with the question of how to afford potentially life-saving medication.
The issue of “chemo parity,” the requirement that insurers cover oral and IV chemotherapy equally, is popping up in legislatures across the country. Rep. Brian Higgins (D-N.Y.) introduced federal legislation last year, and parity measures have been considered in more than 20 states and adopted by several as well as the District of Columbia. Oregon’s law, which was the nation’s first when it took effect in 2008, has expanded access to oral chemotherapy and appears to be working well, insurance regulators and oncologists in that state say.
“We need to level the playing field,” said Baltimore oncologist Paul Celano, president of the Maryland-D.C. Society of Clinical Oncology. Celano recently testified in support of a parity bill in the Maryland General Assembly; the measure did not come to a vote.
Pisano of AHIP says insurers are opposed to such mandates “because they make health care less accessible rather than more affordable” by raising costs.
Medicare officials say they are aware of the problem, but constrained from doing much about it. Medicare has little sway over drug prices, said spokesman Peter Ashkenaz. Solving the problem of unaffordable co-pays and co-insurance would require putting more money into the system or persuading drug companies to reduce prices, he said.
‘That’ll be $10,000’
Steve Yarrington of Topeka, Kan., knew that the Temodar pills his doctor prescribed last year, two weeks after his surgery for a malignant brain tumor, were very expensive. But Yarrington, an unemployed automobile dealer, was shocked when he went to pick up the first month’s supply and was told by the pharmacist, “That’ll be $10,000.”
There must be some mistake, Yarrington said; the pharmacist insisted the amount was correct. “You can just keep it and I’ll go home and die,” Yarrington replied, walking out empty-handed. His wife, Kaye, who recounted the experience in an interview and in January before a Kansas Senate committee considering parity legislation, said he ultimately obtained the drug for free from the manufacturer, after his oncologist interceded.
Cancer specialists say such stories are typical. “We have to hire people to get free drugs for patients,” said Montana oncologist Patrick Cobb, president of the Community Oncology Alliance, a lobbying group composed of cancer doctors. Restricting access to oral drugs is a false economy, in Cobb’s view. Some patients denied oral drugs may deteriorate “and then go on to maybe have a bone marrow transplant for $1 million,” he said.
Jere Carpentier said she and her husband considered taking out a loan to pay for her chemotherapy pills, but decided against it. She thinks they made the right decision: Carpentier wound up needing more rounds of chemo than doctors first thought, and last November, her husband lost his job.
“It would have cost us $24,000,” she said. “That was just too big.”
This story was produced through a collaboration between The Post and Kaiser Health News. KHN is a service of the Kaiser Family Foundation, a nonpartisan health-care-policy research organization unaffiliated with Kaiser Permanente. I would like to thank Allison Klein for helping me get the word out about this very important topic. Cancer patients will all benefit if this equity legistlation passes.
Feel good and keep smiling! Pat