Legislation To Address Out-Of-Pocket Costs For Cancer Patients Heard In Senate Committee

  • Tuesday, February 9, 2016

The Cancer Treatment Fairness Act, SB2091/HB2239, was before the Senate Commerce and Labor Committee Tuesday. Committee members heard testimony from a variety of sources about the benefits of the bill that allows cancer patients to get the treatment that is determined by their doctor to be the best option without out-of-pocket costs being a deterrent, said officials. 

Bill sponsor, Senator Bill Ketron (R-Murfreesboro), a cancer survivor, told the committee why the bill is important to cancer patients across the state and why it is personal for him. 

"I vividly remember sitting beside other patients during my hours of chemotherapy treatments watching them get sick,” Senator Ketron said. “An IV treatment can take six to eight hours, and as I was going through that process, I realized that for many patients it might be easier for them to take a pill at home. Unfortunately, Tennessee is one of only 10 states in the country that doesn’t have a level playing field for cancer patients when it comes to the patient’s out-of-pocket cost of treatment.” 

Scientists are finding more innovative ways to treat cancer, but in Tennessee an outdated benefit structure isn’t always allowing patients to take advantage of those advancements, said officials. 

Oral anti-cancer medications, which are often available in a pill form, can have fewer side effects than traditional therapies. More than 25 percent of new anti-cancer treatments in the research pipeline are in oral form, making patient-administered therapies an increasingly important component of cancer treatment. For a number of cancers, oral anti-cancer medications are actually already the standard of care with no treatment alternatives, said officials. 

"Oral cancer drugs may represent the only or best treatment option in some instances, Dr. Jeff Patton, chief executive officer of Tennessee Oncology, said during his testimony to the committee. "Oral cancer drugs play an increasingly important role in my day-to-day care of cancer patients.” 

Traditional treatments, usually given through an IV or injection, are covered under a patient’s medical benefits resulting in a small co-pay or no cost at all. Oral treatments are usually part of the health plan’s pharmacy benefit and result in high out-of-pocket costs for patients. This disparity can negatively impact patients taking their medication as prescribed, said officials. 

Kelly Owens, an oncology social worker for the past 13 years at Vanderbilt University Medical Center, testified before the committee giving senators specific examples of the challenges she helps patients work through every day. 

“I see patients at the worst times of their lives,” Ms. Owens said. “I see the fears. I see the tears. I hear the agony and anxiousness in their voice when they have to choose to either pay a bill, buy food, or buy their medicines. Just this week I had a patient call crying because she had been without her medicines for one week. These are citizens who work and have insurance.” 

The legislation directs health plans that currently cover cancer treatments to apply the same patient cost-sharing for therapies taken by mouth as those that are administered by IV or injection. It is not a mandate and does not create a new insurance benefit. 

Leukemia survivor, Teresa Leonardi also testified at the hearing so senators could hear her personal story and struggle with out-of-pocket costs for oral anti-cancer treatments. 

“In the end, this will be a life-long battle,” Ms. Leonardi said. “It’s my hope that we can get these drugs at a manageable cost not just for me, but for everyone in this state, because when you're fighting for your life, you don't need to fight bankruptcy over the out-of-pocket cost of your medication.” 

Studies show that oral anti-cancer therapies, when compared with those administered intravenously, not only help decrease overall health care costs, but they also reduce work loss costs, and improve the quality of life for patients, said officials. 

Action on the bill was deferred in the Senate Commerce and Labor Committee. 

Rep. William Lamberth (R-Cottontown) is the bill’s sponsor in the House of Representatives.

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