Insurance Companies Shouldn’t Stand in the Way of Cancer Patients’ Care

By Constance McSherry & MaryLou Gonzalez | January 30, 2023

Cancer is a disease that harms our physical well-being and deeply impacts our identity, daily life, and loved ones. Despite the devastation it causes, we are currently experiencing a breakthrough in cancer treatment. Medical professionals have gained a deeper understanding of cancer’s genetic and immunological causes, which has led to the development of new treatments.

Recent advances in targeted and immune therapies have resulted in a wide range of treatment options, with improved survival rates and fewer side effects than traditional chemotherapy. However, even with these breakthroughs, cancer patients still face obstacles in accessing these life-saving treatments due to insurance companies’ prior authorization policies. These policies involve treating doctors to speak with the insurance company doctor, who questions and potentially denies coverage for recommended tests or treatments.

In New York, the insurance company doctor is rarely trained in cancer medicine and instead allows any kind of doctor to review the case. If you had a plumbing issue, you would not call an electrician to sort out the problem or come up with a solution. Both of these are professionals, but only one is capable. And while all of this process gets sorted out, it delays our treatment, and we wait or abandon treatment altogether due to the difficulties with prior authorization.

We have seen firsthand the impact of insurance company interference in cancer treatment when the insurance company denied coverage for a necessary Neupogen pump during chemotherapy and when an immediate family member was denied a bone marrow transplant despite excellent insurance coverage. It is essential that all cancer patients have access to the care they need and deserve without interference from insurance companies. We must work towards this goal to ensure that no one has to endure the additional stress and hardship caused by insurance company denials.

Given the high stakes for cancer patients, one would hope our state and national government would want to reform this process to help us receive the life-saving medications we need. Yet, two recent government decisions suggest otherwise.

Governor Hochul vetoed legislation for a law passed last year by the New York legislature to improve the clinical peer review process. The law would have stipulated that the insurance company doctor be licensed in New York and trained in the area they review. It would have at least protected patients from under-trained doctors making key medical decisions for their lives.

Now, the federal government Centers for Medicare and Medicaid Services is proposing reform to the prior authorization process to ensure it is more timely and accurate. The problem? The proposed reforms leave out the most critical aspect of our care—medications. This omission effectively excludes cancer patients with the most threatening diseases from the national prior authorization reform that is most desperately needed.

It’s scary, but anyone could become a cancer patient tomorrow. If that happens, you must take the cancer delivery system as it is at that time. Coming back later is not an option. We need legislators that understand this and provide protection for cancer patients to get the treatment they need.

Authors Constance McSherry, parent of a cancer patient, MaryLou Gonzalez, breast cancer patient, members of Community Oncology Alliance Patient Advocacy Network.


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