RENO, Nev. (AP) — Advocacy groups for cancer patients are backing Nevada legislation designed to lower costs for patients on oral medication.
The measure, introduced by Senate Majority Leader Mo Denis on Friday, seeks to make Nevada the 23rd state with what supporters call an oral oncology parity law.
SB266, which has both Democratic and Republican co-sponsors, would require insurers to provide coverage for oral medication that is equivalent to conventional intravenous drugs.
Its introduction comes at a time when some 25 percent of anti-cancer drugs under development are oral medications.
In Nevada, cancer patients usually have a flat co-payment for intravenous drugs with an annual out-of-pocket cap, according to supporters. Those drugs are covered as a medical benefit because they're usually given in a doctor's office or hospital.
But patients on oral drugs usually pay 10 to 50 percent of the drug's cost with no annual out-of-pocket limit, supporters say. Oral medications are considered a pharmacy benefit since they can be taken at home. Oral drugs are expensive, costing up to tens of thousands of dollars a year.
Tom McCoy, an executive with the American Cancer Society Cancer Action Network in Nevada, said the bill seeks to end the disparity facing patients on oral medication.
"What it comes down to is the business model of most insurance carriers hasn't kept up with medical innovation," McCoy told The Associated Press. "You should not have to pay any more for your cancer treatment because you were prescribed to be on an oral drug rather than IV medication. We're trying to achieve parity."
While no immediate opposition surfaced for the bill, supporters expect some insurance carriers to fight it. Representatives of the Washington-based trade group America's Health Insurance Plans didn't immediately respond to a request for comment.
McCoy was unable to provide an estimate for how many Nevadans would be affected by the bill.
Jim Denton, spokesman for the Nevada Cancer Coalition, said he's aware that many patients adversely affected by the current system. Attempts to find patients to comment publicly were unsuccessful as they cited privacy concerns.
In an analysis of more than 10,000 pharmacy claims for oral anti-cancer drugs, 25 percent of patients didn't fill their initial prescriptions if the co-payment amount was more than $500.
"For many people, the costs are literally in the tens of thousands of dollars to pursue this option (of oral medication)," Denton said. "They are being literally held as financial hostages to antiquated health insurance contracts when their primary concern should be how to get better from these terrible diseases, not how to pay for their treatment costs."
There's no evidence the law has increased health insurance premiums in the 22 states that have passed similar legislation, supporters say.