A campaign to have insurance companies treat cancer drugs taken orally the same as they do intravenous cancer treatments has come to North Carolina.
A House committee approved a bill Tuesday that – if it becomes law – would lower the direct cost of medicine for patients who take pills or liquid medicines to treat their cancer.
The bill pitted insurance companies, which say the bill is unnecessary, against health groups, doctors, drug companies and patients, who say the change will allow them to afford the expensive drugs that keep them alive.
Rather than going to a doctor’s office or hospital for chemotherapy, more cancer patients are taking cancer-fighting pills, liquid medicine or capsules at home. The shock to patients’ wallets can be considerable with cancer drugs taken orally.
Chemotherapy at a hospital or a doctor’s office is a medical benefit for which insurance plans usually cap patient out-of-pocket expenses. But drugs from the pharmacist are covered differently, with patients usually paying a percentage of the cost with no annual limit.
Rep. David Lewis, a Harnett County Republican and the bill’s sponsor, said patients should not be harmed because insurance practices have not kept up with medical advances, such as patients being able to take chemotherapy drugs at home.
“As medicine continues to advance, we learn new things every day,” he said.
In recent years, at least 20 states have changed insurance laws to require companies to treat oral drugs as they do intravenous medication.
But Chris Evans, a lobbyist for the state’s largest insurer, Blue Cross Blue Shield of North Carolina, said the new federal health insurance law that caps out-of-pocket charges starting next year covers oral chemotherapy drugs.
In states that have similar laws, insurance companies must give away cancer drugs for free, she said. The bill would take away insurance companies’ ability to control drug costs, she said.
“In reality, cancer drugs are not free, and everybody pays,” Evans said.
Robert Baratta, a lobbyist for America’s Health Insurance Plans, said the measure would make worse the “epic” insurance premium increases expected next year.
“By removing our ability to control costs, you’re just going to add to the premium problem,” Baratta said.
In a letter to legislators, the trade organization said the oral drugs are treated like specialty drugs targeted to a small pool of patients, and are more expensive than established IV drugs.
Some patients take oral chemotherapy because it’s the only option. Amelia Borelli of Oxford said she was hospitalized twice since her 2010 leukemia diagnosis, the first time for six months.
After her second hospital stay, she was prescribed a drug called Tasigna that, with her insurance, costs $1,500 a month.
“I didn’t have it,” said the 68-year-old Borelli, a former consulting firm program administrator. “I’ve been financially devastated since I first got leukemia.”
She’s getting help from Novartis, the drug company that makes Tasigna, but that ends in October.
“Tasigna is the thing that’s keeping me alive,” she said.
Lisa Nelson, lobbyist for the Leukemia & Lymphoma Society, said patients won’t fill expensive prescriptions, citing a 2011 study in the American Journal of Managed Care that found that 25 percent of patients don’t fill prescriptions for oral cancer drugs that cost them more than $500.
She fought a suggestion to make the measure effective in 2015 rather than next year, saying pushing it forward would not help Borelli and other patients.
“That’s the difference between Amelia being able to get her medication in January and pay a reasonable price for it as opposed to her being able to get it 20 months from now and pay a reasonable price for it,” Nelson said. “And for her, that’s the difference between being healthy and being told she has six months to live.”