Bill to address cost of oral chemotherapy

CARSON CITY — Newly developed drugs that can take the place of intravenous chemotherapy treatments to fight cancer are on the market, but the cost to patients can run into the thousands of dollars a month.

State Sen. Mo Denis, D-Las Vegas, wants to change that by requiring insurance companies to treat the cancer-fighting oral medications the same as intravenous treatments provided in hospitals and doctors’ offices.

The disparity arises because IV treatments are medical procedures that are fully covered once a patient’s out-of-pocket maximum has been reached. But health plans typically cover only a small percentage of ongoing prescription drug costs.

At a hearing late last month on Denis’ Senate Bill 266, representatives of insurance companies and small health insurance plans said they will work with Denis to address their concerns with his “oncology parity law.”

The concerns include the cost of another health insurance mandate and the increased costs to smaller health plans when they have to pick up a bigger share of the cost of the new drugs.

REASONS FOR THE BILL

At the hearing in the Senate Commerce, Labor and Energy Committee, former state lawmaker John Carpenter testified in support of the bill.

His daughter Elizabeth Carpenter is undergoing traditional chemotherapy for breast cancer, and the treatments have been hard on her health, he said.

“I can guarantee you that if her treatment was an oral medication, I would sell everything I owned if I needed to if that would get her the treatment she needed to get well,” Carpenter said.

“But it should not come to that, for her or for any Nevadan,” he said. “Her ability to access care should not be contingent on whether her insurer decides to cover her treatment as a prescription drug benefit or a medical expense benefit.”

Carpenter said that nearly 30 percent of all new chemotherapy treatments for cancer patients are oral medications, but insurance plans maintain an artificial distinction between the two therapies.

“People who get cancer, and their families, must deal with so many issues as they battle the disease,” Carpenter said. “They should not also need to battle insurance companies to get the right treatment for that disease.”

Carla Brutico, an oncology nurse, said oral anti-cancer drugs are becoming the standard of cancer care.

“Nevadans with cancer need your help in ensuring that they have access to the best treatment for their diagnosis no matter how it is administered,” she said.

Twenty-one other states and the District of Columbia have passed laws addressing the parity issue.

Denis said he is trying to eliminate the financial disparity so cancer patients can pursue treatment based on medical rather than financial reasons.

Other states have not seen an increase in insurance premiums after adopting such parity laws, he said.

IDEA INDUSTRY ‘CAN WORK WITH’

Bob Ostrovsky, a lobbyist representing the Nevada Association of Health Plans, said the drugs being addressed in the legislation are “enormously expensive,” running as much as $3,200 to $3,500 a month or more.

But he said the policy directive is one “we can work with.”

State Sen. Kelvin Atkinson, D-North Las Vegas, the chairman of the committee, said he has a strong interest in seeing the bill pass for the citizens of Nevada.

“So I hope you are sincere about trying to help,” he said.

Ostrovsky said that he would work with Denis and that he is not trying “to love this bill to death.”

Josh Griffin, a lobbyist for the Health Services Association, said the organizations want the best health care for those who participate in the health plans.

But the plan providers will have to manage the costs, and they should be shared by everyone, he said.

Rusty McAllister, representing the Professional Firefighters of Nevada, said the group would like to work with Denis on the bill, but he said there are concerns about the costs to small health plans, such as the plan operated by the Las Vegas Firefighters Local 1285, which covers about 2,500 individuals.

“We collectively bargain for our health care benefits,” he said. “Every mandate that is put upon our plan means that we cut service and benefits in another area of our plan. We’re barely keeping our head above water right now.”

But Michael Hackett, a lobbyist representing the International Myeloma Foundation, said the bill would not impose a new insurance mandate.

It would only affect plans that list chemo­therapy as a benefit, he said.

“The good news is that most insurers in Nevada cover oral chemotherapy treatments for patients, so the issue is not about coverage, but an inequity in the out-of-pocket costs associated with treatments administered by pill vs. the out-of-pocket costs associated with an orally administered treatment,” Hackett said.

Contact Capital Bureau Chief Sean Whaley at swhaley@reviewjournal.com or 775-687-3901.