Bill seeks parity on costs for anti-cancer pills, chemotherapy

  • Posted: Wednesday, April 24, 2013 1:07 a.m.

RALEIGH (AP) — Health insurance companies would be required to charge North Carolina patients for oral medicines to treat cancer at the same or a lower rate than they must pay for intravenous drugs for chemotherapy under legislation approved Tuesday by a House committee.

The measure was pushed in the House Health Committee by patient advocates. They say insurers are requiring people diagnosed with cancer to pay much more for pills and other oral medicines compared to conventional IV drips offered at a hospital.

“The key word in this is parity,” said Rep. David Lewis, R-Harnett, a primary sponsor of the bill. He said the measure is aimed at “trying to treat the same things the same way.”

Some are being forced to pay thousands of dollars a month in co-pays when chemotherapy may only require $30 or $45 per sitting and the competing regimens produce similar results, speakers supporting the bill said. The sticker shock is causing some patients to give up on treatment, especially when IV chemotherapy doesn’t work for them.

“We are certainly not asking anything for free,” Lisa Nelson, a lobbyist with the Leukemia and Lymphoma Society, told the committee. “We’re just asking to eliminate the discrimination that currently exists for patients receiving oral forms of treatment.”

Health insurance companies oppose the bill, arguing that it will make it harder to keep health care costs in check for all consumers by adding another coverage mandate upon them. Insurers filing their 2014 premium plans with regulators already are expecting significant increases to comply with the federal Affordable Care Act, said Robert Barrata, representing America’s Health Insurance Plans.

“By adding more mandates to this, you’re just increasing the problem,” he said, arguing the bill was more about benefiting pharmaceutical companies.

Blue Cross and Blue Shield, the state’s largest health insurer with 3.7 million members and more than 80 percent of the state’s individual and small business markets, has fewer than 100 members who would be affected by the change, company lobbyist Chris Evans said.

Evans said the language in the bill and experiences in other states with similar requirements means insurers will be “giving away cancer drugs to patients for free.” The new federal health care law also should help these patients starting in 2014 because they’ll be able to receive insurance plans that fit their needs better and there will be a $6,350 annual cap on all of a patient’s out-of-pocket expenses, Evans said.

“We do not believe this bill is necessary,” she said.

Oral treatment should mean fewer side effects for patients and fewer expensive hospital stays, resulting in lower overall health care costs, said Jen Johns with the Washington-based National Patient Advocate Foundation. About half of the states have similar laws on the books, according to Nelson.

Rep. Jim Fulghum, R-Wake and a physician who supported the bill, said doctors are using treatment innovations such as oral medicines to best help the patient, and “penalizing a patient for that is not right.”

Amelia Borelli, 68, of Oxford said her first round of chemotherapy for a form of leukemia nearly killed her, hospitalizing her for six months and placing her in a coma. She was hospitalized again, but now is taking an oral medicine that seems to be working.

Borelli said her health insurance plan was going to charge her $1,500 a month in co-pays for the drug until the pharmaceutical company stepped in and gave her the medicine for free through October for now. Her doctor told her she had six months to live before receiving the oral medicine.

“I’ve been financially devastated since I first got the leukemia,” Borelli said after the committee meeting she attended. “Everybody knows what cancer costs ... and without it people just aren’t going to live. I’m one of those people.”

The bill now heads to the House floor.

Bill would expand aid to Alzheimer’s patients

RALEIGH (AP) — A proposal moving ahead in the House directs North Carolina’s Medicaid program to give additional paid help to people with dementia or Alzheimer’s disease for things like getting dressed and bathed.

The House Health Committee voted Tuesday for legislation expanding coverage hours for personal care services for qualifying patients living at home or in special care units.

The state reduced this kind of care to 80 hours per month in January to comply with federal requirements that services be comparable for people at home or in corporate settings. The bill from Rep. Nelson Dollar of Cary now heading to the House Appropriations Committee would raise the cap to 130 hours.

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