Al­low new cancer treat­ments

The Detroit News - - Front Page - BY JEROME SEID

As­tudy pub­lished in JAMA On­col­ogy last month sup­ports the case for the law­mak­ers to en­act pa­tient-cen­tered leg­is­la­tion to in­crease ac­cess to new forms of cancer treat­ment.

At is­sue are new, more eas­ily-ad­min­is­tered cancer medicines that can lead to bet­ter pa­tient health out­comes, while po­ten­tially sav­ing money for pa­tients and health sys­tems in the long run. These new treat­ments are oral med­i­ca­tions and are al­ter­na­tives to tra­di­tional chemo­ther­apy typ­i­cally ad­min­is­tered in a doc­tor’s of­fice through an in­tra­venous line which is some­times im­planted.

Un­for­tu­nately, Michi­gan is one of seven states re­main­ing in the U.S. that has failed to pass leg­is­la­tion to en­hance pa­tient ac­cess to these new med­i­cal treat­ments.

Be­cause of leg­isla­tive in­ac­tion, many pa­tients face high out of pocket costs for these new cut­ting-edge cancer treat­ments. Many in­sur­ers force pa­tients to pay more to ac­cess these 21st-cen­tury med­i­cal so­lu­tions than they do tra­di­tional IV chemo­ther­apy. Cur­rent law per­mits this sit­u­a­tion, and be­cause these an­ti­quated ben­e­fit de­signs do not re­flect cur­rent clin­i­cal sci­ence, pa­tients are faced with a co­nun­drum with few sim­ple so­lu­tions.

How­ever, new find­ings show there are re­forms that work to save money for pa­tients, at no in­creased costs to in­sur­ers. The JAMA study ex­plored the use of oral drugs for treat­ing cancer, out-of-pocket costs as­so­ci­ated with those treat­ments, and to­tal health plan spend­ing.

The study re­viewed claims as­so­ci­ated with con­sumers liv­ing in one of 16 states that en­acted oral par­ity be­tween 2008 and 2012. The study showed that fol­low­ing en­act­ment of oral par­ity in these states:

Most pa­tients ex­pe­ri­enced a de­crease in out-of-pock­ets costs for orally-ad­min­is­tered cancer treat­ments.

The num­ber of pre­scrip­tions with $0 co­pays in­creased from 15 per­cent to 53 per­cent af­ter pas­sage of the law.

There was no ev­i­dence that health plan spend­ing in­creased af­ter these states changed their laws.

Just 10 per­cent of con­sumers ex­pe­ri­enced any cost in­crease af­ter the change. The study notes this group of pa­tients was al­ready ex­pe­ri­enc­ing higher out-of-pocket costs than the other 90 per­cent of con­sumers in the study. In the end, the study’s find­ings demon­strated a ma­jor­ity of pa­tients ben­e­fited from these laws.

These find­ings un­der­score the need for leg­is­la­tion to cre­ate stronger out of pocket pro­tec­tions for pa­tients in Michi­gan. It is un­con­scionable to, in essence, block ac­cess to the treat­ments pa­tients need to live longer, more pro­duc­tive lives by per­mit­ting cur­rent laws to re­main in­tact. This is es­pe­cially true con­sid­er­ing the lat­est JAMA data re­veal­ing in­sur­ers would ex­pe­ri­ence no in­crease in costs as a re­sult of the change.

The state Se­nate re­cently passed leg­is­la­tion, cur­rently pend­ing in the House, that would help achieve greater eq­uity in how a plan’s med­i­cal and phar­macy ben­e­fits treat cost-shar­ing for oral on­col­ogy med­i­ca­tions. The pre­cise im­pact of this change will vary based on a pa­tient’s in­di­vid­ual ben­e­fit de­sign, how­ever the vast ma­jor­ity of pa­tients will have their fi­nan­cial bur­dens less­ened if the JAMA data as pre­sented holds true .

Pas­sage of these laws has co­in­cided with a pe­riod of change in the health in­sur­ance mar­ket, es­pe­cially as it re­lates to state-reg­u­lated plans. More than ever, pa­tients are be­ing re­quired to shoul­der a greater por­tion of the cost of care. Add the cost of out-of-pocket pay­ments for ur­gent­lyneeded cancer treat­ments, and the ob­sta­cles to care are enor­mous.

It is long past time the Leg­is­la­ture pass leg­is­la­tion to help all Michi­gan pa­tients man­age the out of pocket costs as­so­ci­ated with their cancer treat­ments, and in ac­cor­dance with the grow­ing body of on­col­ogy lit­er­a­ture which sup­ports use of these tremen­dous ad­vances. Jerome Seid, MD, FACP is pres­i­dent of the Michi­gan

So­ci­ety of He­ma­tol­ogy and On­col­ogy.

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