Oral Drug Costs Offer Bitter Pill
From Times Union (Albany, NY) (June 2, 2011)
June 02--ALBANY -- Megan Bonstein's chemotherapy pills costs $11,000 a month. If it were an intravenous chemotherapy, her insurance company would pay for it -- but because it's a pill, she has to pay.
Bonstein and advocates from the Leukemia & Lymphoma Society visited the Capitol on Wednesday to lobby for legislation that would require insurers to cover oral chemotherapy the same way they cover IV chemotherapy.
"For most people, it is cost-prohibitive," said Zina Cary, national director of state affairs for the society.
The New York Health Plan Association opposes the mandate, saying it would increase premiums and could prompt employers to drop prescription coverage.
Under most insurance plans, intravenous chemotherapy is covered as a medical benefit. Patients usually pay about $20 for each IV treatment. Oral chemotherapy is usually covered under the drug benefit that, depending on the plan, requires consumers to pay a percentage of the drug cost.
When Bonstein, 26, of Brookyln, was first diagnosed with chronic myelogenous leukemia in 2009, she was working in New York City and her employer's plan was one of a few that pay nearly the full cost of the drug.
Returning to school, she chose a health plan from Columbia University that covered her medication, Tasigna, but she and her parents didn't realize the plan had a $7,500 cap on prescription drugs. She exceeded the cap in one month. Bonstein applied for financial help from Novartis, the maker of Tasigna, and the company is paying the full cost of the drug for a year.
"I'm very grateful for them helping me, but I don't think it's the answer long-term for everyone," she said.
Tasigna stops the mechanism creating cancer cells, but does not cure it, so Bonstein will be on the drug indefinitely. There are 32 types of cancer like Bonstein's that have oral treatments but no IV equivalent.
Oral chemotherapies began to grow in the early 2000s, driven by genetic discoveries that allow the attack of cancer mechanisms at the cellular level. Today, they are used to treat many cancers -- including breast, prostate, ovarian and brain tumors -- and about 25 percent of drugs under development are oral chemotherapies.
Thirteen states and the District of Columbia requires insurers companies to reimburse oral chemotherapy the same way they pay for IV chemotherapy.
The state Senate approved the bill unanimously last year. The bills are currently in the insurance committees of both houses. The legislation does not affected self-insured plans -- which cover about half of New Yorkers -- because those plans are not subject to state regulations.
Cheaper, but not insured
In some cases, the annual cost of oral chemotherapy is more cost-effective than the price of intravenous chemotherapy.
Metastatic breast cancer
Source: Leukemia & Lymphoma Society
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Posted: June 2011