Craziness in Insurance Land
Generally we are blessed in Massachusetts with our universal health care mandate, and are shielded from many/most of the difficulties and inequities that others face. I well remember the days when many of our residents were uninsured and faced terrible financial problems and decisions at the exact moments that they were also facing a new and terrifying cancer diagnosis. One of the best parts of our state law (and soon to be national policy, too) is the elimination of insurance companies' rights to refuse coverage to someone with a pre-existing condition. This impacts us in a very direct and important way. Since insurance in this country is generally tied to employment, job changes or job loss can mean the end of a particular policy. If the plans offered at a new employer can say "nope, won't cover you as you had breast cancer", women were often forced to stay in jobs (AKA job lock) or did without. People without jobs had even more difficult problems.
Anyway, this editorial from the Boston Globe is about a different issue that does affect us. Medicare (and most insurance companies sooner or later follow the same policies that Medicare uses) covers the cost of IV chemotherapies with a small co-pay. Oral (pill) chemotherapies, however, are covered under the drug benefit, and this means that many people have huge co-pays. Since 2010, eight of the new eleven cancer drugs approved by the FDA, are oral medications, and the trend is increasingly in that direction. This means that many people have bills that may be hundreds or even thousands of dollars per treatment cycle. A bill to address this growing problem has been filed at the State House, and it behooves us all to pay attention and maybe even write or call our representative.
Here is the beginning and then a link:
A tale of two cancer treatments
Every day in Massachusetts, 105 people get diagnosed with cancer, beginning a long, scary and sometimes unpleasant process of treatment. For increasing numbers of cancer patients, it also creates a crushing financial burden for them and their families at a time in their lives when they have enough to worry about.
How is this possible in a state with nearly universal health insurance coverage? The answer lies in the combination of innovation and outdated insurance practices.
Cancer treatment is changing. Increasingly, pills are replacing intravenous chemotherapy administered in a clinical setting. Since 2010, eight of the 11 oncology drugs approved by the Federal Drug Administration are oral treatments.
But insurance companies have been slow to adapt to this change. Insurers treat intravenous chemotherapy as a medical visit, with a modest co-payment and a capped annual out-of-pocket cost, but they treat oral chemotherapy as a drug benefit, for which patients pay a percentage of a prescription's cost, up to 50 percent, and have no annual limit. Chemotherapy agents, whether in oral or intravenous form, are expensive, so those taking a pill face out-of-pocket costs in the thousands and even tens of thousands of dollars every year.