When Beth Whitman’s sister went for a routine colonoscopy in September, 2010, she never left the hospital. Doctors discovered that she had Stage 4 colon cancer, and re-sectioned eight inches of her colon. Her sibling’s unexpected diagnosis prompted Whitman to have a well check-up six weeks later. After reviewing Whitman’s blood work, her doctor called and asked her to repeat a test. She left his office that day with a shocking diagnosis – chronic myelogenous leukemia.
The following day, her blood work was faxed to oncologist/hematologist Dr. David Oubre, who ordered a bone marrow biopsy. That test confirmed her CML diagnosis. “I was diagnosed with CML on a Wednesday, the blood work was faxed to Dr. Oubre on Thursday and by Friday I was at St. Tammany Hospital doing a bone biopsy,” she recalled. “The following Tuesday, I also became a cancer patient.”
Since Nov. 10, 2010, Whitman has been taking Gleevec (imatinib), an oral anti-cancer medication. “It’s a miracle drug, literally,” she said. “It will save your life. Most likely, I would have been dead two years later without it.”
Besides occasional puffy eyes and minimal joint pain, Whitman had no side effects from the treatment. But, there was a major downside – her out-of-pocket cost, with insurance, is $4,700 a month. By contrast, her sister, whose IV chemo treatment was covered by major medical, paid nothing extra. “I happen to have insurance, but some people’s lives are just destroyed,” Whitman observed. “Some people lose their jobs and lose their insurance, but are not poor enough to go on Medicaid. Some people cannot take Gleevec, and their medications can go up to $10,000 a month. None of these medications are generic, so you can’t get a generic price on them. You are at the mercy of the insurance companies.”
Oubre, who practices in Hammond and Covington, confirms these figures. “The medications can go from a few dollars to up to $50,000 or $60,000 a year for one medicine, and are typically covered by insurance,” he says. “The issue is that sometimes, insurance companies will tier medicines to where more specialized medications will require a higher co-pay or co-insurance where patients will have to pay for a percentage of the cost.”
Stories like Whitman’s sparked State Rep. Greg Cromer of Slidell to co-author Louisiana’s “Oral Parity” bill. This legislation, sponsored by Cromer, Rep. Kirk Talbot and Sen. John A. Alario, Jr., requires that healthcare plans provide coverage of oral anti-cancer medications on par with IV drugs. “Essentially, the problem is that currently, insurance companies are covering intravenous applications of chemo under major medical while placing oral treatments under their pharmaceutical benefits,” he explained. “These oral drugs can cost $6,000 to $10,000 per prescription and have 20 to 25 percent co-payments. The bottom line is that the insurers have two forms of money – major medical and pharmaceutical – but they all come from one big bank. We want the co-pays for oral meds equivalent to what you are paying under your major medical for an office visit or treatment at a clinic.”
Cromer also has a personal reason for supporting this legislation – his wife Peggy is a two-time breast cancer survivor, and her mother also had the disease. While Peggy did not have oral chemotherapy, Cromer wants to ensure that other cancer patients will have the best treatment options available. “My daughter is 28 years old, and my concern is that in the future, it may affect her,” he said. “If she does have a problem, then she’s going to need to have the opportunity, as drugs are developed, to address that type of cancer or something she may come up with. I wanted to have the option for other access of service.”
But, the bigger reason, he says, is that all cancer treatments should be treated the same. “If you have an insurance policy that covers cancer care, I don’t care how you deliver the treatment regimen – if you inject it or ingest it or absorb it through your skin – it’s all cancer treatment and should be treated as such,” he emphasized. “You’ve got a standard treatment process right now where you make the care accessible to the public through infusions, and just because you come up with new technology doesn’t mean that the costs should go up. Doctors should have the access to provide that and patients should have access to the care that would be provided by those new drugs. If these new drugs are more directly targeted, then you’d have better outcomes.”
By 2013, oral drugs are expected to make up 25 percent of all cancer treatments, according to the National Comprehensive Cancer Network. “Right now, I probably am prescribing 80 percent IV chemo versus 20 percent oral,” Oubre observed. “In the future, that’s going to change, though. A lot of the newer medicines are being made in an oral form, so it will probably go down to 60/40.”
Most cancers can be treated either by mouth or through an IV. But, for certain types, oral medication is the only choice. “If you have chronic myelogenous leukemia, then oral medication is a choice,” Oubre explained. “If you have kidney cancer or certain types of lung cancer, oral medicine is what you need.”
Oubre has had cancer patients who could not afford oral medications. In those cases, he has sought assistance from foundations to help defray the costs. “That works sometimes, but those foundations won’t always have money and won’t have money for the entire year or from one year to the next,” he noted. “It’s difficult, especially for medicines that are going to be used long-term. In cases like Gleevec for CML, a person may end up being on oral medication for 20 years or more, and at $50,000 a year, you are looking at $1 million for one medicine.”
In April, Cromer presented Louisiana’s oral parity legislation to the House’s insurance committee. “It’s important because it allows patients to receive care for whatever condition they have,” Oubre said. “The issues of the cost to the patient can be held in check so that we can make the best decision for their care.”
Testifying at the House committee hearing support of the bill were Baton Rouge oncologist Michael Castine, along with two staff members and two patients. The measure sailed through committee, passing through the House unanimously. Before going before the Senate’s insurance committee, Cromer added an amendment to include individual as well as group insurance plans. The bill also passed through the Senate insurance committee without opposition. Next step – the Senate floor, then, hopefully, the Governor’s office for signature.
Nineteen states have passed oral drug parity bills, and Cromer fully expects Louisiana to follow suit. “This one is like my Super Bowl,” he said with a laugh. “I’m not going to take losing it lying down.”