Lincoln, Neb.: Insurance companies that cover cancer would have to treat chemotherapy pills the same as medication administered through an IV, under a bill set for a vote as early as Thursday in the Nebraska Legislature.
The measure by Omaha Sen. Jeremy Nordquist seeks to address what supporters see as a disparity between how the two cancer treatments are classified: Insurance policies usually cover the cost of IV chemotherapy as a medical benefit, while oral medications are viewed as prescription drug benefits with much larger copayments.
Nordquist said the idea for the bill came from his brother, an Omaha oncologist, who reported encounters with roughly half a dozen patients who could not afford the preferred cancer treatment in pill form. He pointed to a study by Milliman Inc., a national health care consulting firm, which found that the per-payer increase ranged from 5 cents to $1.50.
"The cost isn`t significant," Nordquist said. "It`s pennies per member, per month."
Fifteen states and the District of Columbia have adopted similar laws. Nordquist said the Nebraska bill is based on a Texas law signed by Gov. Rick Perry last year.
Insurance and business advocates say cost differences, while small, would snowball over time and make it more difficult for small businesses and the self-employed to buy insurance.
"It`s the aggregate effect," Ron Sedlacek, a lobbyist for the Nebraska Chamber of Commerce and Industry, told a legislative committee this month. "The aggregate effect is going to increase those costs and drive employers out of a particular market."
Tessa Foreman of Lincoln had insurance that covered chemotherapy when she was diagnosed with rectal cancer in 2010, but her doctor`s recommendation for a pill-based treatment was denied. Instead, she underwent surgery to have a portable catheter inserted in her chest that delivered the drug directly into her bloodstream.
Complications from the surgery required her to return to the hospital. The 48-year-old suffered from diarrhea and mouth sores that left her unable to eat for seven days at a time — symptoms she might have avoided with a pill.
"I feel like if it were treated the same — as a medical benefit, rather than a prescription — it would have helped," she said.
Shelly Jackson of Lincoln took a second job, spent her life savings and drained her retirement account to cover the copayments for her son`s leukemia treatment, after he was diagnosed at 17. The first drug he needed required a $3,000-per-month copay, which did not apply to her out-of-pocket maximum or coinsurance. Three months later, he was prescribed a second drug not covered by the plan that cost $7,600 a month.
"In hindsight, to stand where I`m at now, I would have been better off to quit my job and go on welfare," she said. "It`s short-sighted from a public perspective to ignore this. These patients are going to end up on public assistance, because there`s no other way. They`re going to end up on Medicare of Medicaid."