Concern over patient access to certain chemotherapy drugs has prompted the Joint Commission on Health Care to research costs and cancer treatment trends in the Commonwealth. The commission has found a disparity in insurance coverage … and is weighing whether a new mandate might be necessary.
With more than 30,000 cancer cases diagnosed in Virginia each year, treatment regimens may include oral or intravenously administered chemotherapy, or both. But Delegate Chris Peace said a constituent told him about an unexpected problem.
“His wife had been offered IV treatment and then ultimately the oral chemotherapy treatment. She developed a tremendous rash and other complications from the IV medications. There were some considerable benefits to the oral. What they found was that the oral was much more expensive because the coverage was different,” explained Peace.
One study found that average out-of-pocket expenses for oral chemotherapy drugs were more than $2900 per month. And one in six cancer patients with high out-of-pocket costs fails to take the medicine as prescribed. The commission’s report said one reason for the disparity is that many insurers count IV treatments as a medical benefit and oral drugs as a pharmacy benefit. The panel said legislation requiring parity may be an option.
–Anne Marie Morgan