Quirk in cancer drug coverage causing disparity

Advocacy groups seek U.S. law killing price disparity that keeps women from pill form of chemo

Cost may be steering some breast cancer patients away from the preferred pill form of chemotherapy.

Many aren't getting those treatments, which can be taken in the privacy and convenience of the the patient's home as opposed to the intravenous drugs given in hospitals and oncologists' offices, because those pills costs thousands of dollars a month versus the infusion drugs that can require a comparatively small co-pay.

Because of the expense difference, caused by a quirk in how Medicare and private insurance plans cover cancer drugs, patient advocacy organizations are fighting for passage of a Cancer Drug Coverage Parity Act, which is languishing in Congress like so many other consumer-friendly ideas.

Terry Wilcox, co-founder and exec director of one of the advocacy groups, Patients Rising, wrote a recent op-ed piece for The Hill — a Washington, D.C., political newspaper and website — that pushes the idea of eliminating the pricing disparity.

Forty-three states have passed laws mandating parity so far, but that doesn't apply to federally mandated plans such as Medicare (or, for that matter, many employer-sponsored plans).

At the moment, oral therapies are classified on the national level as a "pharmacy benefit," burdening patients with the much higher co-payments (in contrast to the "medical benefit" designation for the intravenous treatments). 

The proposed change would make the pills more accessible.

And drop their cost from about $10,000 per treatment to as little as one-fifth that price.

Because of the "cost burden," Wilcox writes, "some patients forego their treatment altogether."

His article cites a new study in the journal Oncology that finds nearly half of cancer patients abandoning chemo therapies when their out-of-pocket expenses go above $2,000.

Wilcox's article notes that, worst of all, "roughly one-third of new chemotherapies only exist in pill form, meaning patients treated with the newest and best therapies have no other option."

Anita DeVine

According to Anita DeVine, co-chair of a Detroit group, Cancer Thrivers Network for Jewish Women, "the extremely high cost of oral chemotherapy is wiping people out [and because] it is so costly, people are not filling their prescriptions and not getting therapy."

Furthermore, she says, "it is predicted that in the next three to five years, up to 50 percent of chemotherapy will be oral."

Partially because of new treatments, including immunotherapies, death rates for cancer have fallen 26 percent since 1991 — resulting, Wilcox maintains, in 2.4 million lives saved.

The Parity Act bill has been introduced bye Rep. Leonard Lance, a New Jersey Republican, and Rep. Brian Higgins, a New York Democrat.

The cost of drugs is further discussed in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at caregivers.

Plans to cut health care costs may be backfiring

Study shows delays in breast cancer testing, treatment due to high deductibles could kill

Delay might be deadly.

Especially when it comes to women getting tested for breast cancer.

Many, however, nevertheless delay their testing and treatment when faced with high deductibles, according to a story by Reed Abelson this week in The New York Times.

High deductible plans, his story, says, "have become commonplace, a deterrent used by [insurance] companies to lower health care costs by discouraging unnecessary tests or treatments."

But those plans inherently carry great risks, Abelson writes, despite their having become much more popular "since the Great Recession 10 years ago [when] people increasingly deferred medical care, putting off elective surgeries and doctors' visits," action that did result in national health care spending slowing.

However, a recent study of women with insurance plans that carried deductibles of at least $1,000, the writer notes, "underscores the danger to consumers required to shoulder a greater share of those costs."

The study also professes that "women who had just learned they had breast cancer were more likely to delay." 

About half of all covered U.S. workers "are now enrolled in plans with a deductible of at least $1,000, and many must pay several thousand dollars in medical bills before their plans even start to cover their care," Abelson contends.

Moreover, a survey of employer benefits by the Kaiser Family Foundations shows "about 11 percent of covered workers have a deductible of at least $3,000" and, the Times story maintains, employers are "more frequently giving their workers no other option."

A review of medical claims, Abelson's article charges, "exposed a pattern: Women confronting such immediate expenses put off getting diagnostic imaging and biopsies, postponing treatment."

Dr. J. Frank Wharam

The piece also quotes Dr. J. Frank Wharam, Harvard researcher and one of the study's authors, to the effect that those women "delayed beginning chemotherapy by an average of seven months."

The bottom line: "Slight delays added up to long delays," Wharam notes in the Journal of Clinical Oncology.

Survival rates are, naturally, higher for patients with some cancers if they're treated early.

In that regard, the Times piece goes on to report that "high-deductible plans pose a problem, say researchers who have studied them, because patients do not always distinguish between the care they should get and what they can do without."

The story also quotes Dr. Peter Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center as it makes a key point: While high-deductible plans are meant to encourage people to think twice about whether a test or treatment is necessary and if it can be done at a lower price, "it's also frankly to impede their use of these services."

Although the plans apparently are succeeding in reducing the use of care, he asks: "The question is, at what cost?"

More insight into how the medical industry deals with the cost of care can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at caregivers.

Writer of book on MysteryDates® needs advice

'Rollercoaster' author seeks your help in picking title of his new volume on relationships

Woody Weingarten

I, Woody Weingarten, need your assistance.

I'm comfortably near the end of the third draft of my new book but am unsure what to call it. So I'd like you to help me pick one of the two working titles.

Please let me know which you prefer and, if you feel particularly energetic, why. 

And if you have any additional suggestions, just send along them to: 
voodee@sbcglobal.net or www.vitalitypress.com/

Here are my finalists at the moment.

Sizzle!

How MysteryDates® can 

recharge your relationship

Hundreds of tips on what you 

can do and see, where to go

— locally, nationally, globally

                  or

MysteryDates®

How to keep a sizzle

in your relationship 

Hundreds of tips on what you 

can do and see, where to go

— locally, nationally, globally

This second book, by the way, is in no way related to my first except that it, too, includes anecdotal material from my three-decade-plus marriage to Nancy Fox, the heroine of "Rollercoaster: How a man can survive his partner's breast cancer," which I aimed specifically at male caregivers.

Thanks for your support.