NASHVILLE, TN — In Tennessee, outdated insurance policies are making it difficult and sometimes impossible for cancer patients to receive the treatment their doctors determine to be the best option.
Tennessee is only one of eight states that does not equalize the patient cost for receiving anti-cancer medication like chemotherapy, regardless of whether it is delivered orally or intravenously. This prevents cancer patients from taking full advantage of today’s innovative medical advancements.
Reps. Brenda Gilmore (D-Nashville), Mike Stewart (D-Nashville) and Sen. Steve Dickerson (R-Nashville) are co-sponsoring SB0922/HB1059 that aims to reduce barriers to access for cancer patients and would mean that the patient cost share would be more aligned regardless of whether chemotherapy treatment is administered intravenously or orally. The bill is not a mandate and does not create a new insurance benefit.
“Cancer patients should be able to get the treatment their doctor believes is best for them without a significant cost difference regardless of whether it is intravenous or oral chemotherapy,” Gilmore said.
“Treatment is treatment, and the right treatment is crucial for patients,” Stewart said.
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.
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.
“This bill is not an insurance mandate,” Dickerson said. “It doesn’t mandate coverage of oral chemotherapy. The legislation merely says that if a health plan does cover cancer treatment that patients’ out-of-pocket cost should be similar no matter how the treatment is administered.”
The Leukemia & Lymphoma Society leads a coalition of stakeholders that strongly supports the legislation and are grateful for the efforts of Reps. Gilmore, Stewart and Sen. Dickerson and prime sponsors Sen. Bill Ketron (R-Murfreesboro) and Rep. William Lamberth (R-Cottontown).