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Connecticut seeks to cover chemo pills

Many insurance plans treat such drugs as prescriptions, and charge accordingly.

March 13, 2010|By Arielle Levin Becker

Reporting from Hartford, Conn. — "Hallelujah," Kim Green remembers thinking. Her life was about to get easier.

For nearly a decade, she'd been making trips to the hospital, spending full days hooked up to machines that delivered chemotherapy to fight her breast cancer.

She was about to start a new type of chemotherapy, two drugs in pill form, that she could take at home in West Hartford. It wasn't just convenient, it was crucial: The port in her chest that had been used to deliver the chemotherapy intravenously had become infected, and her veins were too damaged to use.

But nearly a year and a half later, Green, 45, wishes she could go back to the old method.

"It's been an enormous financial strain," she said.

Getting the chemotherapy intravenously cost Green $20 in co-payments when she went for treatment every three weeks. Her health insurance picked up the rest.

But for the pills, Green pays $300 to $500 a month.

Although insurance often covers most or all of the cost of chemotherapy when administered intravenously in a medical office, many plans treat the pills as prescriptions, which typically require patients to pay a much larger share. That can mean a difference of hundreds of dollars a month.

Connecticut lawmakers are considering a bill that would require insurance plans covering intravenous chemotherapy to cover oral chemotherapy the same way. A handful of states, including Vermont, Hawaii and Oregon, have such laws. Insurers and the Connecticut Business and Industry Assn. oppose the measure, saying it could raise the cost of insurance and make it tougher for companies to offer coverage.

Opponents also raise concerns about potential disadvantages of oral chemotherapy -- patients not taking their full doses or receiving chemotherapy without the direct medical supervision they get during an intravenous treatment -- and the cost of the oral drugs.

Supporters, including cancer survivors, doctors and patient advocates, say it's a matter of fairness, a way to ensure that treatment decisions are driven by the best medical option, not the cost.

And doctors say the oral chemotherapy can cost less than the intravenous version because it does not require medical professionals to administer it.

Oral forms of chemotherapy have existed for decades, but they have taken on a more prominent role in recent years. Experts estimate that a quarter of the anti-cancer agents in development would be administered orally.

In some cases, oral drugs have no intravenous equivalent. The drug Gleevec, for example, treats chronic myelogenous leukemia and comes only in pills. At wholesale rates, it costs about $3,800 a month, or $45,600 a year, according to Novartis, the drug's manufacturer.

For other cancers, including breast cancer, oral chemotherapy drugs represent an addition to an arsenal that already includes intravenous chemotherapy.

But from the perspective of treating cancer, whether a drug is delivered through a pill or through an IV makes no difference, doctors say.

"If the intent is to cover cancer care, these new drugs are as much a part of cancer care as anything that I've given intravenously historically," said Dr. Robert Siegel, an oncologist and medical director of cancer clinical research at Hartford Hospital.

Siegel supports the legislation but shares the insurance companies' concerns about the price. He wonders about the country's ability to manage the cost.

"There's no question that making the insurers pay for these drugs is putting a financial burden on the insurance companies, because they're expensive," he said.

Green has missed doses, she says, sometimes because insurance problems delayed her prescriptions. On her last cycle of one of the medications, the pills arrived four days late.

"Psychologically, it's huge," she said. "I'm like a fanatic about it, because it's my life."

Sometimes, Green feels guilty about how much money goes toward her medical care instead of her children's college fund. She feels conflicted as she speaks out.

"I'm just so grateful . . . to have these drugs, period. I'm grateful to have insurance, period," she said. "It just seems so kind of backward that it would be more difficult for the pills to come to my door than it was to make a trip to the hospital."

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