Pennsylvania House legislators voted overwhelmingly to pass a bill that will equalize patients’ out-of-pocket expenses for oral and intravenous cancer treatments. Pennsylvania is the 35th state, in addition to the District of Colombia, to institute laws that require insurance companies to cover oral chemotherapy drugs under no less favorable terms than traditional infused forms.
Most U.S. private and public health insurance policies cover oral and intravenous medications separately; oral medications are covered under a patient’s pharmacy benefits, while intravenous drugs are covered under medical benefits. Cancer patients receiving intravenous chemotherapy treatments in an outpatient setting are usually required to pay a flat copayment of approximately $20 – $50. In contrast, patients given the option of choosing oral chemotherapy must go through their pharmacy plan, paying as much as $2,500 out of pocket every month.
Historically, most chemotherapy drugs have been administrated intravenously. However, advances in cancer care have led to a growing proportion of available oral agents. These drugs have an advantage over traditional intravenous drugs as they require a patient to take less time off of work and may provide more targeted treatment, thus improving quality of life, and possibly prognosis.
Pharmacy benefits often have a tiered copayment structure, with patients chipping in as much as 25%. These plans may also have overall high deductibles and caps on annual drug benefits, making oral chemotherapy cost-prohibitive for many. Statistics show the high expense of cancer care is associated with higher rates of personal bankruptcy. Other studies have indicated that patients subjected to higher out-of-pocket expenses are less likely to adhere to their oral chemotherapy regimens.
Chemotherapy equality laws, such as those recently passed in Pennsylvania, address these issues by targeting the glaring disparity in the amount cancer patients are required to pay for treatments. Critics, however, argue that affordable patient access to expensive oral treatments will only serve to shift the cost of the drugs to insurers, who will in turn pass the expense on to all policyholders.
Though the laws have been praised by law makers, physicians, and patient advocates, many also say the laws fail to address the root of the problem – the exorbitant and ever-increasing costs of new cancer drugs. Many of these drugs cost as much as $100,000 per year, and prices are only going up every year as new drugs come on the market. Some argue that by not distinguishing between higher- and lower-value agents, these laws ignore the emerging national debate over the appropriateness of using expensive cancer treatments that provide only a marginal benefit compared with less costly alternatives.
Philadelphia Mesothelioma Lawyers at the Shein Law Advocate for Patients’ Rights to Quality Cancer Care
If you have been diagnosed with mesothelioma or another illness resulting from the negligence of another, the Philadelphia mesothelioma lawyers at the Shein Law can help you obtain the financial compensation you and your family are entitled to. Our offices are located in Philadelphia, PA and Pennsauken NJ, allowing us to represent clients throughout Pennsylvania and South Jersey. Contact us online or call 877-SHEINLAW (877-743-4652) today to schedule your free consultation with one of our experienced New Jersey mesothelioma lawyers.