Imagine hearing that you have cancer — words each of us dreads for ourselves and our loved ones. Now imagine hearing that the treatments you need to fight it, medications your doctor specifically prescribed, are beyond your financial means simply because of the way you would take them — orally instead of intravenously (IV).
This is the issue countless cancer patients across Florida are experiencing. It's also the reason why the upcoming session of the Florida Legislature is so important to providing cancer patients with equal access to medications regardless of whether those drugs come in the form of a pill or through an IV.
Orally-administered cancer treatment is becoming an increasingly important component of cancer care. In 2008, less than 10 percent of cancer medications existed in an oral form. This year, that number is expected to grow to at least 25 percent. For some types of cancer, orally-administered medications already are the standard of care.
Yet insurance benefit design has not kept pace with these advances in treatment. Under some insurance plans, cancer patients who receive their medication orally will face out-of-pocket costs ranging from hundreds to thousands of dollars per month, even if that particular medication is the only treatment available. However, patients who receive their cancer treatment intravenously are typically responsible for covering only the cost of an office visit co-pay, usually $20 or $30 dollars per visit.
This disparity exists because coverage for an IV-administered medication is usually provided under a plan's medical benefit, whereas orally-administered medications are typically covered by a plan's pharmacy benefit. This distinction is hugely significant, as pharmacy benefits often require patients to cover a much higher share of the cost.
In 2008, the Oregon Legislature passed a bill intended to address this problem. Today, 21 states, plus the District of Columbia, have enacted similar laws, usually known as "parity legislation." But, unfortunately, Florida is not one of these states.
Consequently, cancer patients in our state will continue to face high cost-sharing for orally-administered cancer treatments. This keeps these life-saving medications out of reach for far too many patients, reducing their quality of life and sometimes threatening their chance of survival. In many cases, an orally-administered treatment is the only one available, forcing cancer patients to choose between family financial stability and the treatments they badly need.
Orally-administered cancer treatments offer many other benefits. For example, they can be less burdensome to patients than IV-administered cancer treatments. Also, patients taking orally-administered cancer treatments may take their medications at home rather than having to make frequent visits to an infusion clinic, thus reducing costs and easing inconveniences associated with travel to the doctor's office, leave from work and, in many cases, caretaker assistance. These benefits can make a profound impact on a patient's ability to maintain employment throughout treatment and, more generally, on their overall quality of life.
The Alliance for Access to Cancer Care is dedicated to ensuring that parity legislation is passed in Florida this year. That's why the alliance fully supports The Cancer Treatment Fairness Act, recently filed in the Florida Legislature by Rep. Debbie Mayfield (HB 301) and Sen. Lizbeth Benacquisto (SB 422). I urge our legislators to show their support of these bills in order to help the countless patients in Florida experiencing unjust hardships while they fight a battle for their lives.