The last part of my article yesterday announced the following:
“The governors of Colorado and Kansas enacted legislation providing out of pocket relief for those cancer patients taking chemotherapy in pill form.”
Changes in laws to help the growing number of cancer patients who are using oral chemotherapy medications are begining to emerge on the state and federal levels. The American Cancer Society (ASC)is partly responsible. So is the International Myeloma Foundation (IMF). Before I post an article relating to the subject of gaps in insurance coverage for cancer patients this morning, I would like to share with you a statement a good friend of mine, Stacey, sent out by e-mail recently:
The oral chemo I am taking is $7000.00 a month. Our copay is $1500.00 a month. That is a extra house payment a month to stay alive. Luckly we have been able to manage for now. This is a important bill for cancer patients.
Ouch! Now remember, if Stacy was using IV chemotherapy, she would have little or no cost. Here is the first part of the article I promised:
Gaps in insurance policies make oral drugs too pricey for some cancer patients
By Sandra G. Boodman – Kaiser Health News – Tuesday, April 27, 2010
When Jere Carpentier learned last year that she had advanced colon cancer — her third malignancy in a dozen years — she worried about spending hours in a clinic tethered to an intravenous line, enduring punishing chemotherapy that would make her hair fall out. Her veins ruined by earlier treatments, Carpentier was elated when her oncologist said this time she could avoid needles and take a pill at home that would specifically target the cancer cells and spare her hair. “I let that be the thing that made this okay,” she recalled.
But the former human resources manager, who lives in San Jose, soon discovered that her insurer would not pay for the pill called Xeloda, which cost $4,000 per month, because a cheaper IV drug was available. So instead, she underwent surgery to implant a port in her chest through which she received 46-hour-long chemotherapy infusions, mostly at home. One night the device, which included a large needle that constrained her every move, sprang a leak and began emitting a shrill alarm, requiring a race to the emergency room. “It was the scariest thing that happened to me,” Carpentier, now 60, recalled, “and I’d been through two cancers.”
Scary and also unnecessary, in Carpentier’s view. “Surgery for the port and the ER visit alone cost more than it would have for them to cover the damn pill,” she said.
Like Carpentier, a growing number of patients are being denied access to newer oral chemotherapy drugs or are required to shoulder hefty out-of-pocket costs, sometimes thousands of dollars a month, for cancer pills with annual price tags of more than $75,000. The reason is rooted in a reimbursement system that covers IV chemotherapy as a medical benefit but considers less-invasive oral chemotherapy to be part of a patient’s drug plan, which tends to be far less generous. Some plans cap drug benefits at $5,000 annually, which can amount to less than a month’s supply of chemotherapy pills. The disparity is likely to affect increasing numbers of cancer patients, because 25 percent of 400 chemotherapy drugs in the development pipeline are oral.
A recent report by the consulting firm Avalere found that oral cancer drugs, which account for about 10 percent of chemotherapy treatments nationwide, are typically placed in the most expensive price tier in insurance and Medicare Part D drug plans, where out-of-pocket costs can reach 35 percent. People covered by Part D plans in 2010 must shell out $4,550 before they get through the coverage gap called the doughnut hole, after which they pay 5 percent.
“If a drug costs $3,000 a month, most of the patients we help cannot afford to come up with $1,000 a month,” said Nancy Davenport-Ennis, founder of the nonprofit Patient Advocate Foundation of Newport News, Va., which helps people pay for treatment. Most cancer patients, she notes, take several medicines, not just one. The new health-care coverage law will close the doughnut hole by 2020, but it does not specifically address the financial obstacles to oral chemotherapy, oncologists say.
Although some new oral drugs have demonstrated only incremental benefits, extending life for several weeks, others represent genuine advances and have transformed once rapidly fatal cancers into manageable diseases.
“I’ve got two grandkids, and I thank the Lord every day I wake up and get to see them,” said William Bunch, 65, a former factory mechanic in Suffolk, Va. On Christmas Day 2000, Bunch was told he had chronic myelogenous leukemia (CML) and a life expectancy of about two years. Soon afterward he began taking a then-experimental drug called Gleevec, which he has been on ever since. “Without it I’d die,” he said.
“Gleevec is the treatment for CML: There is no IV alternative,” said oncologist Douglas Blayney, medical director of the Comprehensive Cancer Center at the University of Michigan. “It can really give people their lives back.”
But growing numbers of leukemia patients are having trouble obtaining the drug because they can’t afford it. The Government Accountability Office recently reported that the average annual negotiated price of Gleevec in Part D plans jumped 46 percent between 2006 and 2009, from $31,200 to $45,500, raising the average out-of-pocket cost for a year’s supply from about $4,900 to more than $6,300.
Insurance industry officials say that the high cost of oral drugs, not paltry reimbursement rates, are the primary obstacle. “If you look at a drug that costs $60,000 a year, the real question is, ‘Why does it cost $60,000 a year?’ not ‘Why doesn’t a plan cover it?,’ ” said Susan Pisano, a spokeswoman for America’s Health Insurance Plans, the industry trade association. “Our member companies are trying to do everything they can, but I would say this is a real hardship for people.”
But Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America, the trade association for drug companies, defended the price of oral chemotherapy drugs, citing the “very long, risky and expensive” process of developing them. Cancer drugs “deliver good economic value” and “represent a small share of health-care costs overall,” he said in a statement. Patients who need help paying for them can receive free or low-cost medicines through programs sponsored by drug companies, he said.
This is a very long, but important article. I will run the rest tomorrow.
Feel good and keep smiling! Pat