Cost is one of the main barriers for access to oral chemotherapy, but Roswell Park leaders believe cancer patients should know that their chemotherapy drugs will be covered regardless of whether they receive it through an infusion at a doctor’s office or cancer center or they take it with a glass of water in their home.
RPCI is advocating for a bill pending in Albany that would treat oral and intravenous (IV) chemotherapy similarly with respect to insurance coverage. Currently, some insurance plans reimburse oral chemotherapy as a prescription drug, which means these therapies may be subject to an annual cap or an expensive co-insurance, putting these therapies out of reach.
Megan’s Story: “I have insurance but can’t afford the medication I need.”
Columbia University Master’s student Megan Bonstein was diagnosed with chronic myelogenous leukemia (CML) in early 2009. Her health insurance plan includes an annual prescription drug cap of $7,500 — not enough to cover the cost of even one month of Tasigna, the medication she needs to treat her cancer. Tasigna is an oral chemotherapy agent that costs approximately $7,700 to $11,000 per month.
“I have insurance, but I still can’t afford the medication I need because of the way that insurance covers my medication,” said Bonstein.
Oral chemotherapies are often the best — and many times the only — treatments available for cancer patients, and many of the emerging and most effective cancer therapies are available only in pill form. But many oral drugs require much higher out-of-pocket costs for patients than IV chemotherapies, making the treatments difficult for many patients to afford.
About the Proposed Legislation
A bill (S. 3988 / A. 6233) introduced by state Sens. Andrew Lanza (R-Staten Island) and Ruth Hassell-Thompson (D-Bronx) and Assemblymember Vito Lopez (D-Brooklyn) requires that oral chemotherapies be covered at a cost equal to intravenously delivered chemotherapies, ending a cost disparity that has left countless cancer patients without access to oral chemotherapies.
Working with RPCI, The Leukemia & Lymphoma Society, Susan G. Komen for the Cure, the American Cancer Society, the International Myeloma Foundation and other partners, Bonstein has recently met with key New York legislators, urging immediate action on this legislation.
“We are simply asking that all chemotherapies be covered in an equitable, cost-effective way for all patients,” said Zina Cary, national director of State Affairs for The Leukemia & Lymphoma Society. “Just charge reasonable co-pays like you would for a doctor visit, which is how IVs are treated. It’s the best way to level the playing field for all patients.”
“There is absolutely no reason why life-saving medicines should be covered differently simply because of the way they are administered,” said Sen. Andrew Lanza. “This bill is about keeping up with the times and the changing face of medicine.”
This bill is strongly positioned for consideration and passage before the current legislative session ends, and RPCI and our partners have been successful in our efforts to make sure state lawmakers are well informed about the disparity in coverage that exists currently.
Similar laws have already been enacted in 13 other states and the District of Columbia.