Cancer patient battles the disease as well as PBMs – pharmacy benefit managers
Fifteen years ago, I watched my beloved 26 year-old sister Charlie die of melanoma. There were no viable treatments in 2003, and she passed away nine months after being diagnosed.
But today there is reason to be hopeful. Scientists and doctors are working hard to find innovative ways to battle cancer and improve patients’ lives. And their efforts are paying off. More effective, less debilitating and easier to administer therapies are now available for many cancers.
Many of these new therapies are easier to administer because they come in pill form rather than being administered intravenously or injected in liquid form, an enormously important innovation for both patients and healthcare providers.
Many insurance plans, however, refuse to cover oral cancer treatments at the same rate as intravenous or injected cancer treatments. The discrepancy is likely related to how insurers traditionally classified medications, but recent medical advances have wiped out those distinctions. Now, some of the most powerful cancer therapies come in pill form.
Because some of the newer, more effective treatments are administered orally, insurers’ failure to update their reimbursement policies creates a situation where potentially better treatments are cost prohibitive for many patients. This discrepancy in coverage can be tens of thousands of dollars each year, a difference that forces some patients to delay their recommended treatments – or forgo them entirely.
The discrepancy in coverage also means some patients are simultaneously battling cancer and their insurance companies in order to access the treatment they need at a fair price. Insurance appeals can take months, and when a patient is fighting cancer, a few months’ delay is potentially deadly.
Thankfully, however, there’s a bill in Congress that would bring fairness to cancer treatment coverage.
The Cancer Drug Parity Act would ensure that all cancer treatments, including oral treatments, are covered at the same rate for patients, no matter how the treatments are administered. This legislation, which is cosponsored by California Congresswoman Doris Matsui, will end the out-of-pocket cost disparity for cancer treatments based solely on how insurers classify medicines.
Insurance plans that force patients to pay more for oral cancer treatments are already unfair and outdated, and they will become more so as new treatments emerge. It’s estimated that25 to 35 percent
of all new cancer treatments in development are oral therapies. Insurance coverage policies need to be updated now to reflect the current cancer treatment landscape.
As a cancer advocate, I work every day with patients who are thankful for the advances in medical research that have created these new options for treatment. But they are angered by insurance coverage that would require them to pay significantly more for a treatment simply because it is swallowed rather than injected or delivered intravenously. Many have to choose the less expensive treatment option regardless of whether it is the most effective or appropriate treatment for their cancer. I am glad my family was not faced with a choice like this.
I applaud Matsui for her leadership on this important legislation. Representatives Ami Bera, Ro Khanna, Paul Cook, John Garamendi, Nanette Diaz Barragan, Lucille Roybal-Allard, Jackie Speier, Eric Swalwell and Adam Schiff have all signed on to support the legislation, and I encourage the other members of the California delegation to join with their colleagues to advance this common-sense bill that will ensure rate parity across cancer treatment therapies.
Cancer treatments are advancing, but many insurance plans are not. Let’s take a needed step forward by bringing insurance plans up to date through the Cancer Drug Parity Act.