MILWAUKEE (WITI) — Cancer patients across the state are rejoicing as a three-year long battle to get insurance companies to cover oral chemotherapy the same way they cover traditional IBV chemo, is over.
Most insurance companies cover traditional chemotherapy, administered in a hospital or clinic, as a medical procedure. Oral chemotherapy is covered as a pharmaceutical benefit, making it much more expensive for patients.
Gov. Scott Walker has signed a bill, the Cancer Treatment Fairness Act, into law. It is designed to lower the cost of chemotherapy drugs in pill form for cancer patients. Walker signed the measure Thursday, April 3rd at the Froedtert and Medical College of Wisconsin Clinical Cancer Center.
In one of the most memorable bill-signings in his tenure as Governor, Walker was surrounded by hundreds of cancer patients and their doctors who feel the new law will save many lives.
“It effectively just provides parity, so that if someone’s got a health insurance plan that provides chemotherapy, now going forward, that plan has to provide parity when it comes to providing it orally,” said Gov. Walker. “It’s a win all the way around.”
The Republican-sponsored bill passed the Legislature with bipartisan support, after initially being kept from a vote by Republican leaders. The bill was controversial, however, because insurance companies viewed it as a government mandate on private businesses.
“It’s the beginning of an argument that any expensive drug should be dealt with that way,” said insurance industry lobbyist Jim Buchen.
Cancer patients and doctors say the law is essential.
“Some of the best chemotherapies that have the most effectiveness, they only come as a pill. So, it’s not like there’s an IV equivalent, and a lot of these patients couldn’t afford it,” said Dr. James Thomas with the Medical College of Wisconsin.
One study showed out-of-pocket costs for cancer medication averaged more than $2,900 in 2009 — up 17% from 2008. Leukemia survivor Jennifer Grandkoski has spent more than $50,000 on oral chemo in the last decade.
“It was a really high cost that was just prohibitive and almost prevented me from being able to take the medication,” said Grandkoski. “I was paying hundreds and hundreds of dollars every ten days.”
Under the new law, out-of-pocket costs will be limited to $100 — something Grandkoski says she can live with.
Nearly 30 other states have similar legislation.
“In line with the majority of states, we are a little bit late — but better late than never,” said oncologist Dr. Parmeswaran Hari.
The new law will take effect in January, 2015.