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Denis B. Hammond, MD: NH oral chemo patients get stuck with outrageous bills

February 23. 2015 12:29AM

IF YOU are unlucky enough to be diagnosed with Chronic Myelogenous Leukemia and live in New Hampshire, out-of-pocket costs for one month of life-saving medicine are likely to be $1,700. If you live in any other state in New England, the same medication could cost as little as $25 out-of-pocket each month. Hundreds of Granite Staters with a wide variety of cancer diagnoses often face similarly prohibitive costs.

How can this happen? The reason is that most health insurance companies cover the pill form of chemotherapy under a different benefit category than intravenous chemotherapy, and thus they pay for the two treatments differently. That means a cancer patient may be required to have thousands of dollars on hand to give to the pharmacist before the pharmacist will dispense oral chemotherapy.

The patient needs this pill to stay alive, just like a diabetic might need insulin to stay alive, but how can he or she afford $20,000 a year just for this one drug? Many patients cannot. They skip doses or stop the medications, hoping the disease will stay away till they have the money to pay for their treatment.

State Sen. Jeb Bradley and others in the Legislature are courageously trying to correct the problem of the high out-of-pocket costs of oral chemotherapy by introducing Senate Bill 137. This bill is very much like the ones that have been passed in 34 other states and the District of Columbia, which address the disparity in cost of oral versus intravenous chemotherapy.

Under such legislation, commonly referred to as “oral chemotherapy parity,” commercial insurance companies that cover intravenous and oral chemotherapy cannot charge patients more out-of-pocket costs for the oral chemotherapy than the patient would have paid for intravenous chemotherapy. Further, the companies cannot raise the out-of-pocket cost of the intravenous chemotherapy just to make up for money lost by reducing the out-of-pocket costs of the oral chemotherapy.

As a doctor, I know that when a person hears “you have cancer,” the ensuing worries can be overwhelming. A fear of not being able to obtain the most effective treatment for the disease as a result of cost should not be one of these worries. Although New Hampshire has a mandate for insurance companies to pay for chemotherapy, science has outpaced the insurance industry.

Currently oral chemotherapy may be a more effective option than intravenous treatment; sometimes it may even be the only option. However, these drugs are not included in the state’s mandate. As a result, the sky high out-of-pocket costs of oral chemotherapy can force cancer patients to compromise their cancer care.

I have seen firsthand how this disparity in coverage can affect a cancer patient who is already facing extreme hurdles fighting his or her disease. It is simply unfair to further burden a cancer patient by subjecting him or her to sky high treatment costs simply because the treatment comes in a pill versus an IV.

In New Hampshire, a group of public health and medical organizations including the American Cancer Society Cancer Action Network (ACS CAN), the Leukemia and Lymphoma Society, the National Brain Tumor Society and the Northern New England Clinical Oncology Society (NNECOS) have joined together to advocate for oral chemotherapy parity in our state. The coalition is urging state lawmakers to make New Hampshire’s laws protecting cancer patients similar to those of most other states of our nation.

On behalf of cancer patients across New Hampshire and their families, please contact your state senator and representative and encourage them to support SB 137.

Denis B. Hammond, MD, is a Manchester-based oncologist and member of the Coalition for Oral Chemotherapy Parity.

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