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Fair treatment for all cancer patients

Our lawmakers in Annapolis have an opportunity to eliminate a significant disparity in access to chemotherapy for the thousands of Marylanders treated for cancer each year. The access issue is one of cost and the difference in how much insurance companies require patients to pay for intravenous chemotherapy vs. oral chemotherapy.

Simply put, when cancer patients are treated with intravenous chemotherapy drugs — which for years were virtually the only treatment option — their share of the costs under most insurance plans is limited to office visit co-pays, usually about $20 or $30 per session. But when oral chemotherapy drugs are the course of treatment, many cancer patients find themselves relying on the pharmaceutical portion of their health insurance, requiring them to pay a percentage of the cost of the drugs. Far too often, that monthly charge to patients can be $1,500 or more, a prohibitive cost to many patients.

For many specific types of cancer, the oral cancer therapies attack the cancer with greater precision and fewer side effects. In 2009, oral therapies accounted for approximately 10 percent of cancer treatment. It is estimated that by 2014, oral therapies will account for 25 percent to 30 percent of all treatments. These oral therapies often represent standard-of-care treatments, and in many cases there are no intravenous equivalents.

But the cost impact on patients has created heartbreaking situations, some of which patients shared recently with members of the General Assembly. Oncologists across the state are now familiar with stories of families who are forced to max out their credit cards to cover the costs of their these lifesaving chemotherapy drugs; patients who cut the proper dosages in half to reduce costs; and others who simply ask whether there's any other form of chemotherapy treatment, even if it's less effective. A recent study published by the Journal of Oncology Practice and American Journal of Managed Care found that 10 percent of cancer patients failed to even fill their initial prescriptions for oral anti-cancer medications, and that out-of-pocket cost is a significant factor.

The legislatures and governors in 15 states (including New York and New Jersey) have concluded that this access gap is unacceptable, and they have passed legislation to solve the problem.

The Maryland Senate and House of Delegates are now considering the Kathleen A. Mathias Chemotherapy Parity Act of 2012 (Senate Bill 179 and House Bill 243). The legislation is named in honor of Kathleen A. Mathias, the wife of Sen. James Mathias of Ocean City, who lost her battle with cancer. The bills have bipartisan support in the Senate and House of Delegates, as well as the backing of a diverse group of patients, physicians, nurses and other advocacy groups.

The legislation is fairly straightforward. If insurance companies provide coverage to Marylanders for chemotherapy treatment, they would be required to equalize out-of-pocket patient expenses for intravenous and oral anti-cancer treatments.

The most obvious objection to this legislation is that it could potentially drive up costs for us all. But studies of costs and insurance rates in states that have implemented similar legislation have found no noticeable effect. In fact, CareFirst BlueCross BlueShield has told legislative analysts here in Maryland that it does not anticipate any significant fiscal impact.

Dr. Joshua Sharfstein, Maryland's health secretary, has formed a work group in Annapolis composed of lawmakers, health professionals and advocates to try to find a solution. Maryland's oncologists welcome his interest and urge our lawmakers to pass this bill during this year's session, maintaining Maryland's reputation as a leader among states in health reform.

While it may be tempting to wait to address access disparities until national health care reform is fully implemented in 2014, Marylanders who have cancer don't have the time to wait. They need treatment now, and they need to have access to whatever form of chemotherapy is deemed by their physicians to be the most effective option.

Maryland has a reputation in our nation as a state that aggressively attacks disparities in access to health care. We urge the General Assembly and Gov.Martin O'Malleyto build on our well-deserved reputation in the area of chemotherapy treatment for cancer.

Dr. Paul Celano is chief of the Division of Medical Oncology at the Greater Baltimore Medical Center and president of the Maryland/DC Society of Clinical Oncology. His email is pcelano@gbmc.org.

Copyright © 2014, The Baltimore Sun
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