A state law requiring parity in what chemotherapy is covered by insurance companies goes into effect Monday, making Nebraska the 20th state to require oral chemotherapy to be treated the same as intravenous cancer treatments for insurance purposes.
Sen. Jeremy Nordquist of Omaha, who spearheaded the legislation in Nebraska, said the lack of parity in coverage between intravenous and oral chemotherapy medications is a growing problem. Some cancer treatments cost $5,000 to $10,000 a month, and some patients are being forced to pay high out-of-pocket costs for chemotherapy taken orally.
"This ... will make life-saving cancer treatments more accessible and affordable for cancer patients," he said. "The decision about the best course of treatment, whether it be IV chemo or chemo in a pill form, will be made between patients and their doctor, not dictated by their insurance company."
Nordquist said research shows that when confronted with the reality of high out-of-pocket expenses, many cancer patients forgo expensive therapy and discontinue treatment, in part because they do not want to saddle their families with unmanageable debt.
And because oncologists know how expensive oral medications can be, he said, they often do not prescribe them -- even when they think that would be the best option.
The actuarial and benefits consulting firm Milliman Inc. did a study in 2010 that estimated that requiring similar coverage for oral chemotherapy would cost less than $6 a year per person in most insurance plans. The study was paid for by GlaxoSmithKline, which makes and is developing oral chemotherapy drugs.
Nebraska joined New Jersey, Virginia, Maryland, Delaware, Hawaii and Louisiana in enacting such a law this year. The District of Columbia also has chemotherapy parity law.
The National Patient Advocate Foundation is among several groups pushing for such legislation on the state and federal levels.
"We believe that every cancer patient should have access to the most appropriate treatments recommended by their physicians and should not suffer from cost discrimination based on the type of therapy provided or the mechanism for the delivery of that therapy," said Nancy Davenport-Ennis, CEO of the foundation. "We are pleased to see that residents of Nebraska will now be free of these potential treatment barriers."