Robert Adler was shocked at 50 when what seemed like pneumonia was actually multiple myeloma, a cancer of the blood and bone marrow. He was in for another shock when he found out that his first monthly prescription for an oral anti-cancer drug would cost $3,200.
Adler, of Laguna Hills, said friends and family helped him come up with more than $42,000 for the Revlimid pills he needed for a course of treatment. But he plans to travel to Sacramento on June 27 to testify in favor of a bill that would make the cost of anti-cancer pills similar to the cost of IV therapy.
“As a cancer patient, you have enough going on without the stress of wondering what’s going to happen if I can’t take my meds,” Adler said.
Assemblyman Henry T. Perea, D-Fresno, introduced the bill after talking to cancer patients and their families at the infusion center where his mother was receiving intravenous therapy for lung cancer.
Perea said many were forced to spend hours in the large, open room, attached to IV drips, because they could not afford their share of costs required under their health insurers’ pharmacy benefit for cancer pills taken at home. In contrast, the cost of IV treatment was low for them – typically the cost of an office co-pay.
Perea said aligning the costs of cancer treatments for insured patients would cost policyholders pennies per month, a claim backed up by a nonpartisan policy analysis.
Similar laws have passed in Minnesota and Texas, allowing some cancer patients to choose to stay home.
“Where California is usually leading in U.S. policies, we are far behind, and we need to catch up,” Perea said.
Office of Henry Perea Assemblyman Henry T. Perea, D-Fresno
Perea said the bill has gained the support of Democrats and Republicans as it passed hurdles in the state Assembly. It faces votes in the state Senate and is by no means a certain winner.
Gov. Arnold Schwarzenegger vetoed two bills like Perea’s in 2009 and 2010. He cited concerns about adding costs to insurance premiums and about meddling in a problem that stands to be eliminated by federal health reform.
The California Association of Health Plans, which represents insurers, is fighting the bill, also on cost grounds.
“The question is, should every most expensive treatment be required to be paid for when there are less expensive treatments?” said Patrick Johnston, chief executive of the association. “If you say yes, then who pays the cost? It goes on the bill of everyone who buys insurance.”
Susan Pisano, spokeswoman with America’s Health Insurance Plans, a Washington, D.C.-based group, said the group has opposed similar laws across the country.
Piecemeal mandates on health insurers tend to push coverage costs out of employers’ reach, according to Pisano. “There are thousands of mandates around the country that have the opposite effect that their sponsors have intended,” she said.
In California, a nonpartisan group examines the effects of legislation that would change health insurance mandates. The California Health Benefits Review Program concluded that if Perea's bill passes, the law would affect three out of 1,000 patients with health insurance who need non-generic cancer treatment pills.
It estimated that Perea's bill would save those patients nearly $2.7 million during the year after the bill is implemented.
The monthly cost to each health insurance customer would be less than 4 cents per month, the analysis shows.
Alison Ramey, a Sacramento-based lobbyist with the American Cancer Society, said her organization supports cancer treatment parity laws. Also, she said, some types of cancer are best treated by oral medications, and more remedies are expected to be developed as pills.
"It's unfortunate that people are put in a situation where they have to make a choice to fill a prescription and fight the disease or pay their mortgage or their child’s day care," she said.