Traverse City Record-Eagle

Opinion

November 14, 2013

Forum: Cancer Treatment Fairness Act needs to be passed

On behalf of the Michigan Society of Hematology and Oncology (“MSHO”), we encourage the Michigan Legislature to pass House Bill 4751, the Cancer Treatment Fairness Act.

MSHO is a state-based professional organization which currently represents over 93 percent of all practicing hematologists and medical oncologists in Michigan. It is the mission of MSHO to promote exemplary care for patients with cancer and blood disorders through advocacy, education and research.

The American Cancer Society estimates that 57,560 new cancer cases will be diagnosed in Michigan in 2013. Five years ago, less than 10 percent of cancer drugs existed in oral form. Today oral medications are reported to account for up to 35 percent of the current oncology pipeline making oral drugs an increasingly important component of cancer treatment. For some types of cancer, oral drugs are the singular standard of care.

Insurance benefit design has not kept pace with advances in oral anti-cancer drug therapy. This has resulted in patient cost sharing obligations that are much higher for oral anti-cancer drugs than for drugs delivered to cancer patients through infusion (OV) or injection. This disparity exists because cost sharing for an IV or injected drug is usually provided under a plan’s medical benefit, whereas oral drugs are typically assigned to a plan’s pharmacy benefit. Oral cancer drugs relegated to the plan’s pharmacy benefit can require out-of-pocket costs ranging from hundreds to thousands of dollars per month. Patients believing that they had a cancer benefit are now faced with difficult financial choices they did not anticipate. We believe these life-saving decisions are best left to the physician in consultation with their patients.

House Bill 4751 would require insurance companies to treat oral anti-cancer therapies in the same manner as existing cost sharing policies for IV or injected therapies. This legislation is critical to prohibiting payers from discriminating against orally-administered drugs and triggering the threat of patients abandoning their treatment.

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