On December 11, 2013, Carli Good (Susan G. Komen® Greater Kansas City Executive Director) and Theresa Osenbaugh (Community Health Manager) visited the Missouri State Capitol in Jefferson City to provide testimony on oral parity and what it means to cancer patients in our state. Present to hear the testimony were members of the Governor appointed Missouri Oral Chemotherapy Parity Interim Committee. The appointed committee was charged with studying the disparity in patient out of pocket costs between orally and intravenously administered chemo therapies, the reasons for the disparities, and the patient benefits in establishing parity.
We urge all who have a moment to reach out to their local state representatives and encourage them to join on as co-sponsors of the bills. Click here for Missouri State House members’ contact information. A similar bill will be filed in the Senate as well. Click here for Missouri State Senate contact information.
As the bill(s) move through the legislative process, we expect them to be referred to committees made up of our state representatives. The committees they are referred to will likely hold hearings where members of the public are invited to provide testimony. Public testimony is vital to the passing of this bill. We want to shine light on what this means to cancer survivors-many of whom are already paying for a cancer plan on their insurance but still find themselves without coverage.
We need you! If you have ever been given the opportunity to take oral chemotherapy and would be willing to submit written testimony or speak in person in Jefferson City when it comes time, please let us know! Click here to email Theresa Osenbaugh if you are interested in testifying.
Below is the previous testimony presented by Carli Good:
Testimony of Carli Howard Good, Executive Director
Susan G. Komen Greater Kansas City Affiliate
Presented to the Missouri Oral Chemotherapy Parity Interim Committee
December 11, 2013
Mr. Chairman and Members of the Committee, thank you for the opportunity to provide testimony about oral parity, which would require that insurance companies cover orally-administered anticancer medications on terms no less favorable than intravenously-administered or injected cancer medications. My name is Carli Good, and I am the Executive Director of the Greater Kansas City Affiliate of Susan G. Komen®. My testimony is on behalf of the Greater Kansas City, Mid-Missouri and St. Louis Affiliates.
Cancer is a national and state epidemic. In 2012 alone, over 1.6 million people in the U.S. were diagnosed with cancer and nearly 570,000 died. In Missouri, more than 33,000 new cancers were detected and more than 12,700 people died. The latest data from the Missouri Cancer Registry shows that over 4,400 Missouri women are diagnosed with breast cancer per year.
Komen is the world’s largest grassroots network of breast cancer survivors and activists fighting to save lives, empower people, ensure quality care for all and energize science to find the cures. Thanks to events like the Komen Race for the Cure, we have invested more than $2.2 billion to fulfill our promise, working to end breast cancer in the U.S. and throughout the world through ground-breaking research, community health outreach, advocacy and programs in more than 50 countries.
In 2013, the Komen Greater Kansas City, Komen Mid-Missouri and Komen St. Louis Affiliates have granted more than $3.1 million into our local service areas to cover local breast health education and breast cancers screening and treatment programs.
Oral Parity in Missouri
The Komen Missouri Affiliates support oral parity in Missouri. We believe health decisions should be made between a patient and her/his doctor. These decisions will depend on many factors such as age, type of cancer and the characteristics of the cancer; deciding on a particular treatment option is as much a personal matter as it is a medical one. Treatment decisions should not have to be based on financial factors; the decision should always be based on what is best for the patient. In addition, persons with cancer should be protected from high out-of-pocket medical costs that could lead to financial hardship and even bankruptcy.
Cancer chemotherapy is the use of anti-cancer drugs to kill or disable cancer cells. It is a treatment option for many types of cancer, but it is used differently depending on how advanced the cancer is. Cancer chemotherapy drugs can be taken orally by pill or capsule, or injected intravenously. Typically, a combination of two or three chemotherapy drugs is used. Intravenous drugs must be given in a hospital or physician’s office.
The emergence of safe, clinically effective oral chemotherapy has significantly increased the treatment options for cancer patients. According to the National Comprehensive Cancer Network, some 400 anticancer medications are currently under development and about 25 percent of them are intended as oral anticancer medications, which will be used to treat 52 different types of cancer. The most frequently prescribed oral medications are used to treat breast, ovarian, endometrial, and uterine cancers. In discussions with local researchers, we also have learned that oral chemotherapy drugs are expected to be the main source of anti-cancer drug in the future. While oral chemotherapy is available and will become an even more prevalent treatment option in the near future, there are many barriers that impede the use of this treatment option.
There can be a significant difference in the amount cancer patients pay out of pocket for an oral drug and how much they pay for an intravenous product. Intravenous therapies are traditionally covered under a medical benefit, under which most patients are only responsible for an office co-payment for each visit and are not required to pay a separate fee for the intravenous drug. By contrast, oral chemotherapy is generally covered under a prescription drug benefit, which tends to have higher co-payments or no coverage at all.
Oral chemotherapy drugs can be extremely expensive. And because of oral chemotherapy’s higher levels of cost sharing, patients may be exposed to very high out-of-pocket costs. While some co-payments have remained low, particularly for generic drugs, some cancer patients face out-of-pocket costs of hundreds or even thousands of dollars a month.
We strongly believe that a health plan that provides coverage for cancer chemotherapy treatment should not require a higher co-payment, deductible, or co-insurance amount for a prescribed, orally administered anticancer medication than what is required for an intravenously administered or injected cancer medication, regardless of formulation or benefit category determination by the health plan. We support efforts by the state to require health insurance plans to provide coverage for oral cancer drugs on terms no less favorable than the coverage provided for intravenously-administered chemotherapy. At the same time, we must ensure that in adopting this policy, health insurers are not allowed to reduce benefits for intravenous therapies.
Other states are leading the way. Already, Kansas, Oregon, Indiana, Iowa and Vermont passed oral chemotherapy parity legislation, and legislation is pending in a number of other states.
The Komen Greater Kansas City, Komen Mid-Missouri and Komen St. Louis Affiliates of Susan G. Komen support oral parity. We support efforts at the state and federal level to require group and individual health insurance coverage and group health plans to provide coverage for oral cancer drugs on terms no less favorable than the coverage provided for intravenously-administered chemotherapy. At the same time, we must ensure that in adopting this policy, health insurers are not allowed to reduce coverage for intravenous therapies.