NJ politicians must provide financial relief for patients unable to afford life-saving medicine
We live in a time of remarkable medical innovation. But too often, the result of these incredible advances is a cruel financial burden for the patients trying to gain affordable access through their insurance company to life-saving treatments.
As a physician who treats patients with cancer on a daily basis, I find comfort knowing – now more than ever – we have medicines that can effectively counter the disease in many of its forms. But as I watch patients often forced into choosing between paying for their cancer treatments or other basic necessities, the critical need to remove financial barriers to desperately needed medicine couldn’t be clearer.
Even as the Affordable Care Act has helped limit out-of-pocket expenditures for those who are suffering, the cost-sharing that insurance plans require patients to pay before they reach those thresholds remains high. In 2017, the average out-of-pocket limits were $6,950 for bronze plans, $6,094 for silver and $4,108 for gold. Not all plans are offered in every county, either, meaning some patients have no choice but to opt for the more expensive plans.
As hard as this may be, the story is even more dire for patients taking pills to treat their cancer. For one type of cancer managed almost only with pills (chronic myeloid leukemia), the average outof-pocket cost was $2,372 in 2017 – every month, for a medicine that is usually needed for the rest of the patient’s life. And for many oral medicines to treat cancer – so-called “specialty medications” – patients’ monthly payments can be $6,000 or more, and some are just flat out not covered.
The costs become overwhelming for people who urgently need these medicines for themselves or family members. They are making decisions between basic living expenses and their
medications. Some resort to stretching a onemonth supply of a drug to two, or they’re having to cut back on necessities to simply afford these crucial prescriptions. Appallingly, some simply can’t afford to receive treatment and are left at the mercy of their untreated cancer. This month alone, one of my patients had to decline treatment for his progressing leukemia because he simply didn’t have the money to pay for the medicine, and another whose lymphoma was rapidly progressing admitted that she was only taking her medicine every third day because she hadn’t been able to afford her monthly copays.
Imagine having to make the choice between your child’s leukemia medication or a full refrigerator. What good are these drugs if you’re going hungry because of the price your insurance company is forcing you to pay – despite paying your monthly insurance premium so you have insurance and theoretical access to needed care? This cannot be allowed to continue. Solutions exist, if we have the collective will to see them through. A bill requiring health insurers to limit insurers’ shifting of cost onto patients and providing an appeal process concerning prescription drug coverage has been referred to the New Jersey General Assembly’s Appropriations Committee. With few exceptions, this statute would limit a covered person’s out-of-pocket costs (including copayment and coinsurance) for prescription drugs to no more than $100 per month for a 30-day supply of any single drug.
This bill took over four months to move through the Financial Institutions and Insurance, eventually passing in June with a resounding 11-0 vote. However, the same legislation was introduced in the New Jersey Senate’s Commerce Committee in February, with no action since.
There are few among us that have not been touched by cancer. Cancer patients, their family members and all citizens of New Jersey must demand action from their lawmakers. Reach out and urge them to take the next step toward reining in insurers and ensuring that all patients, regardless of means, have equal access to life-saving medicine. Make your voices heard.
In this time of sharp political divisions, the need for more affordable prescription drug prices is a rare area of universal consensus. But it’s up to each of us to make sure our representatives remember that.
Dr. Matthew J. Matasar is a medical oncologist and hematologist who cares for people with lymphoma, including Hodgkin lymphoma and non-Hodgkin lymphoma. He is the Chief of Medical Oncology at Memorial Sloan Kettering Cancer Center Bergen.