WHAT OTHERS SAY: Missouri insurers must consider new forms of cancer treatment

Friday, February 28, 2014 | 2:06 p.m. CST

Health insurance providers in Missouri have been ducking their obligations to pay for new forms of cancer treatment, those that involve pills and liquid ingestion instead of intravenous drugs.

Now there’s an actuarial study, doctor and hospital support and plenty of testimony from patients that should convince the Missouri legislature to require that providers must cover oral cancer treatments.

If that’s not enough, how about the fact that 27 states and the District of Columbia have enacted laws to ensure that patients have access to oral anticancer therapies?

Oh, best of all, for this legislature, it has nothing to do with Obamacare.

The main argument from insurance providers is that oral chemotherapy coverage will cause premiums to rise. They’ve also called it a coverage “mandate,” like that’s a bad thing. The legislation’s chief backer in Missouri, Rep. Sheila Solon, R-Blue Springs, won’t hear that.

“Every time they would say the word ‘mandate,’ the word ‘parity’ would come out of my mouth,” Solon said Tuesday. “It is not a mandate. This legislation would not order coverage for anything that insurers are not already covering. It just provides coverage for it in a pill rather than through a needle.”

Small impact on premiums

As to the argument about higher premiums, there is significant evidence debunking the industry’s cost estimates. In 25 of the 27 states that provide coverage, there was no impact on the insurers’ cost, said Debbie Kersting, executive director of The Leukemia & Lymphoma Society-Gateway Chapter. She added that in the two states where premiums rose — Washington and Connecticut — they went up an average of 16 cents a month per premium.

At the outside, Missouri health insurance premiums would rise an average of 57 cents a month if a law were enacted to require equal coverage for oral chemotherapy, according to an actuarial study by Lewis and Ellis Inc. of Overland Park, Kan.

One need only look back at the effort to have autism treatment be included in insurance coverage to be reminded of how much the industry inflates its estimates of the financial impact of new kinds of coverage. When bills were moving through the legislature to try to get coverage for autism treatment, the insurance industry claimed the requirement would boost premiums up to 3 percent.

The legislation was approved in 2010, and 3,000 Missourians now have health insurance that covers treatment for their autism. The cost of that treatment is nowhere near what the industry had predicted. A new study by the Missouri Department of Insurance, Financial Institutions & Professional Registration shows that the impact on overall claims cost last year was 0.2 percent.

Treatment evolves

Oral cancer drugs are not a new treatment, but the same treatment that is currently covered in a different form. The reason for the industry whining is a reimbursement system that covers IV chemotherapy as a medical benefit but oral chemotherapy as a pharmaceutical benefit. That sort of coverage is far less generous, with some plans capping drug benefits at $5,000 annually.

Cancer pills can be expensive, with annual price tags that can exceed $75,000. Most cancer patients can’t afford that so, without insurance coverage for the treatment, they resort to IV chemotherapy.

That treatment, which is covered by Medicare and private insurance, has some costs that exceed the treatment itself, such as implanting a port to convey the drugs, and the loss of jobs, as people have to take off time from work to spend hours hooked to an infusion machine.

A bill recently approved by the Missouri Senate bars health insurers from requiring higher co-pays and deductibles for oral chemotherapy than for IV treatments and caps the patient out-of-pocket cost at $75 per prescription.

It also would prohibit insurers from increasing the cost to patients of IV chemotherapy so that it would be equal to the higher cost of oral chemotherapy.

Solon said this was the first time in three years that representatives of the insurance industry have not testified against such legislation. She takes that as the industry’s tacit acknowledgement that change is coming, and that they’re going to try to manage what form that takes, rather than continue to resist.

David Smith, a lobbyist for Anthem Blue Cross Blue Shield of Missouri, did not testify against the bill but said the legislation could be changed to lower the cost to insurers and noted that a Kansas law doesn’t have the prohibition on raising the cost of IV chemotherapy.

Benefits of oral treatment

Oral cancer treatment is, for many cases, the new best-practice for treating the disease, say supporters of the legislation. Kersting said 35 percent of all new cancer treatments are being released in pill form only.

Medical studies show the pills target cancerous cells more effectively than broader intravenous chemotherapy and have fewer side effects, including typical problems like fatigue, nausea and hair loss.

Cancer is a common enemy. It is neither Republican nor Democrat. Making it easier for patients to stay home while taking medicine that is more targeted for their needs just makes sense. It’s time for lawmakers to listen to the people.

Copyright St. Louis Post-Dispatch. Reprinted with permission.

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