CHARLESTON, WV – Longtime health care lobbyist Nancy Tonkin’s ongoing battle against cancer unexpectedly placed her at the local forefront of a growing national trend toward insurance parity legislation.
Tonkin, founder and president of Tonkin Management Group, was diagnosed in late 2013 with Stage IV lung cancer that metastasized into her bones and liver. She began taking the oral anti-cancer drug Tarceva ® at the recommendation of her oncologist. Tarceva, administered daily in pill form, attacks only aberrant cells and not other, healthy cells in the body, resulting in fewer side effects.
“I was fortunate to get signed up for a grant to help cover the patient co-pay component,” Tonkin recalled. “I did not realize how much it was going to be monthly until July, when my grant ran out.”
Under Tonkin’s health insurance policy, she pays half of all pharmaceutical costs. Tarceva costs $6,000 per month. From July through December 2014, Tonkin paid $3,000 per month for the daily chemotherapy medication, in addition to other medication co-pays and her monthly insurance premium.
In the future, West Virginia’s new health insurance parity law will ease the financial burden for patients like Tonkin. Recently signed by Gov. Earl Ray Tomblin, the law prevents insurance companies from charging higher copayments, deductibles or coinsurance for oral anti-cancer treatments in comparison with traditional intravenous therapies.
“This important legislation removes roadblocks and improves access to care for an often life-threatening illness,” Tomblin said. “All West Virginians can identify with this issue, because, unfortunately, we all have family members or know someone who is affected by cancer. We want to assure that treatment decisions always are made in the best interests of the patient.”
The legislation, HB 2493, unanimously passed the state Senate on March 12 after clearing the House of Delegates in a near-unanimous vote on Feb. 24. Effective on June 10, the new law brings West Virginia in line with the surrounding states of Ohio, Kentucky, Virginia and Maryland. A federal bill, known as the Cancer Drug Coverage Parity Act, has been introduced in Congress.
“Oral medication parity at the state level is an important step in addressing access inequality for cancer patients,” said Raymond Wezik, global advocacy executive for the International Myeloma Foundation. “The IMF hopes that Congress will take note of what West Virginia and 36 other states plus the District of Columbia have done across the country to ensure patients can afford their doctor-prescribed treatment.”
The cost disparity occurs because traditional intravenous therapies are covered under the medical provisions of health policies. Oral anti-cancer medications, taken at home, are covered under a policy’s pharmaceutical provisions, which often have higher copays and deductibles.
“Oral therapies allow patients to lead a more normal life, because they can be administered in the comfort and convenience of home,” said Delegate John B. McCuskey, chair of the House Banking and Insurance Committee. “By keeping out-of-pocket expenses on a par with traditional IV therapies, we don’t punish patients who choose this option or are directed to this option by their doctor. Furthermore, certain anti-cancer drugs are available only in oral form, so the disparity presented a question of access, which this bill now solves.”
McCuskey added, “Most importantly, I am proud to have worked with providers and insurers and patients to craft a bill that will make life just a little easier for those who are suffering through a most difficult time in their lives.”
Overall, oral medications actually may reduce costs to the health care system because they don’t have to be administered in a clinical environment, and don’t require IV ports, health care personnel and time. There is also a cost savings benefit to employers and employees because patients don’t have to take time off from work.
“This is good, compassionate legislation that will be helpful for many patients,” said Sen. Ed Gaunch, vice chair of the Senate Banking and Insurance Committee. “My understanding is that insurance premium cost adjustments are nominal, if any are necessary at all.”
Gaunch further explained, “Our bill doesn’t mandate that insurers cover oral chemotherapy. Instead, it simply requires that if a health plan does cover chemotherapy, the patient’s out-of-pocket costs must be the same, regardless of how the therapy is administered – orally or intravenously.”
Requirements under new law apply to policies or contracts issued or renewed after Jan. 1, 2016. The legislation also allows for health insurance company cost containment measures if the cost of compliance exceeds 2 percent of the total cost of coverage.
Thomas J. “Thom” Stevens
Government Relations Specialists
Office Phone: (304) 344-8466
Email: [email protected]
Raymond L. Wezik
International Myeloma Foundation
Office Phone: (443) 824-0931
Email: [email protected]