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Proposed Legislation Would Give Cancer Patients Improved Access to Life-Saving Treatments Prescribed by Physicians

1/24/2013

CONTACT: Karen Moore, APR, CPRC
(850) 224-0174
         
Tallahassee, Fla. (January 23, 2013) – Working to protect the rights of Florida cancer patients, Representative Debbie Mayfield and Senator Lizbeth Benacquisto have sponsored legislation that will increase access to life-saving, orally administered cancer treatments. The bill, titled The Cancer Treatment Fairness Act, would protect patients from having to pay higher out-of-pocket costs for a cancer medication that is taken by mouth than for a cancer medication that is administered intravenously (IV). The proposal applies to plans that already cover cancer treatment; it does not require health plans to cover cancer treatment.

“These patients and their families are literally fighting for a life and we should do everything we can to make certain that our insurance system treats them with compassion, respect and fairness.  The choice between oral or intravenous treatment should be left to the patient and his or her doctor and devoid of financial pressure that result from unnecessary and archaic insurance coverage laws,” Representative Mayfield said.

Under the current insurance benefit design in Florida, patients who receive oral medications to combat cancer may face between hundreds and thousands of dollars in out-of-pocket expenses each month while undergoing treatment. However, cancer patients who receive their treatment by IV are typically responsible for covering the cost of only an office visit co-payment—usually $20 to $30—when they receive their IV-administered medication in a medical facility. This disparity exists because coverage for an IV-administered cancer medication is usually provided under a plan’s medical benefit, whereas orally administered cancer medications are typically covered by a plan’s pharmacy benefit.

Such high cost-sharing sometimes forces patients to choose a less appropriate treatment or, worse, to forego their prescribed medication. In many cases, there are no other treatments that can be substituted for the prescribed oral medication, as most cancer treatments do not come in both an oral format and an IV format. Here, the choice to incur a large financial burden for an oral medication becomes a life or death decision. Yet orally administered medications may help patients avoid financial instability; the convenience of orally administered medication may help reduce missed days at work both for patients and their caregivers. In turn, this may diminish the likelihood of financial instability resulting from job loss and may also lead to a reduced reliance on short- and long-term disability.

“Our focus should be on the patient and ensuring that our laws keep pace with advancements in medicine in a way that makes sure to treat patients fairly,” said Senator Benacquisto.

Chief Financial Officer Jeff Atwater became involved in this issue after Floridians called on his Division of Consumer Services to help them reduce the high out-of-pocket expenses required to obtain the orally administered cancer treatment recommended by their doctor. In one recent plea for help, a consumer’s co-payment was $45 for IV-administered cancer treatment. But when he went to fill the prescription for the orally administered version prescribed by his doctor, he learned that he now was required to pay $2,300 monthly for the same medication.  In response, CFO Atwater supports legislation that requires insurers to cover orally administered cancer treatment in the same manner as IV-administered cancer treatment.

“Floridians who are fighting cancer should be able to focus on beating the disease without added anxiety over whether they can afford the form of treatment recommended by their doctor,” CFO Atwater said.  “My office has received calls for help from consumers who were disturbed and disheartened by this unfair policy.  Along with the sponsors of this legislation and on the behalf of all Floridians battling cancer, we will work to remedy this injustice.”

In 2008, less than 10 percent of cancer medications existed in an oral form, according to Susan G. Komen for the Cure®. This year, that number is expected to grow to at least 25 percent. If the bill becomes law, Florida will join 21 other states, plus the District of Columbia, in addressing a longstanding disparity in access to orally administered cancer treatment. The bill has broad support from multiple patient and health advocacy organizations, as well as physicians and nurses in the oncology field.

Members of the Alliance for Access to Cancer Care include:

• Florida Affiliates of Susan G. Komen for the Cure
• Florida Breast Cancer Foundation
• Florida Medical Association
• Moffitt Cancer Center
• Florida Society of Clinical Oncology
• Florida Osteopathic Medical Association

Alliance for Access to Cancer Care

The Alliance for Access to Cancer Care is a collection of patient advocacy groups, health advocacy organizations and companies, physicians, and nurses joined in support of orally administered cancer treatment parity legislation in Florida. The Alliance was established in June 2012 with the goals of educating and engaging lawmakers, media and the public of the importance of proposed cancer treatment parity legislation and its impact on patients. The group is dedicated to ensuring cancer patients have equal access to the treatment most effective at combating their disease—whether treatment is orally or intravenously administered.