LEVEL THE PLAYING FIELD FOR CANCER TREATMENT INSURANCE COVERAGE
Cancer patients in New York and across the country are suddenly facing a Sophie’s Choice. While Covid-19 has changed all our lives, from the way we work to the way we shop, for cancer patients there is one fundamental thing that hasn’t changed—the need for treatment to manage their cancer.
And for many, this means choosing between staying in the safety of their homes and postponing or foregoing treatment or risking exposure to Covid-19 in order to get their chemotherapy or radiation. This is especially true in New York, where the risk is high and transportation challenges are great.
The oncology social workers at CancerCare hear about these challenges every day from our clients. They hear from patients anxious and fearful because their chemotherapy treatments have been reduced due to physician concern about them traveling for treatments while their immune systems are compromised. They speak to caregivers worried that they can’t be with their loved ones during infusions, which can last for hours.
It is truly a Sophie’s choice – leave the safety of your home and risk contracting a lethal virus or stay home and risk compromising your cancer prognosis from lack of or delayed treatment.
It doesn’t have to be this way. Many cancers can now be treated with oral medications, which would solve the dilemma for many patients. Unfortunately, a lot of patients can’t afford these oral treatments because of the way that insurance companies bill for them
Infused treatments provided at a doctor’s office or hospital are usually billed as a doctor visit, which has a low or no co-pay. Oral anti-cancer medications, however, generally fall under the prescription drug benefit, which can mean all the difference in what the patient must pay. Most insurance plans charge patients a percentage of the cost of prescription medications and this can translate into enormous, and unaffordable bills.
This disparity can be fixed, but we need Washington to step in to make that happen, by helping change the way insurance companies cover the cost of oral anti-cancer treatments.
States have already addressed the problem in the health plans they regulate by passing legislation requiring equal cost sharing coverage for all anti-cancer treatments, no matter what form they come in. But without federal legislation, the millions of Americans who have health plans regulated by the federal government do not have this protection, even if they live in a state like New York that has an oral-parity law on the books.
My organization is joining with dozens of others across the cancer community calling on federal lawmakers to act quickly to protect cancer patients from the no-win choice of treatment or exposure.
As Congress considers the next COVID -19 relief bill, I urge New York’s federal delegation, along with House and Senate leadership to do the right thing for cancer patients and add a provision requiring oral chemotherapy drug parity. By adding language that has already been proposed and vetted in Washington, you can expand options for doctors and patients, improve the ability of cancer patients to both protect themselves and continue treatment, and provide peace of mind to those who will no longer have to choose between the risks of two terrible diseases.
Patricia Goldsmith is CEO of CancerCare, the leading national organization providing free, professional support services and information to help people manage the emotional, practical and financial challenges of cancer. In FY19 CancerCare programs and services helped 174,600 people affected by cancer. Our professional oncology social workers provided emotional and practical support to 79,842 people through our Hopeline, individual counseling, support groups and community programs. CancerCare provided $39.7 million in financial assistance to 24,767 people to help with treatment-related costs such as transportation, home care, childcare and co-payment assistance.