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Thursday, May 19, 2011 07:11 pm

Who will pay for chemo pills?

Bill would require insurance to cover oral cancer treatment

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An insurance lobbyist testified at the Illinois Statehouse May 11, but not on behalf of a company. Heather Wright spoke on behalf of a House bill that could have improved the quality of life for her late father, who died from stomach cancer in 2010.

House Bill 1825 would require health insurance companies to cover oral medication in the same way as intravenous feeding tubes or other related injection of chemotherapy treatment. Currently, cancer patients are not covered by health insurance for the pill form of chemotherapy and some must travel for hours to receive treatment, as did Wright’s late father, Roger Gribben, who lived in Robinson, Ill.

“If the insurance company would have covered the oral pill, my Dad wouldn’t have had to go to Terre Haute, Ind., every day to get the chemo. He would have just taken the pill at home,” says Wright.

Gribben couldn’t keep down solid foods and doctors gave him a nutrient liquid called Peptamen. Unable to maintain a healthy weight, he lost 50 pounds in three months.

“Your dad is supposed to be this invincible man that can conquer the world, and to see him basically deteriorate to nothing. . . .” she says.

Gribben’s wife would take off time from work to drive him to Indiana because it was the closest facility for chemotherapy treatment. He traveled back and forth between the facility every other week, often nauseous on the hour drive each way. Some days he would only get 30 minutes of chemotherapy and some days he would need three hours.

An oral treatment was too expensive for Gribben and his wife, something that the bill’s sponsor, Rep. Ann Williams, a Chicago Democrat and friend of Williams, couldn’t overlook.

“To keep that inaccessible to patients is not in the best interest of anyone, in terms of financial cost or in human cost,” says Williams.

“Some health insurance companies simply have not structured their benefit plans to keep up with the amazing advances in cancer treatment.” She adds that this bill would allow Illinois to follow the lead of 10 or 11 other states that provide consistent insurance no matter the form of treatment.

With oral treatment, patients are less nauseous, less likely to lose hair or be as sick compared with the intravenous treatment.

Robert Mocharnuk is an associate professor of medicine in the division of hematology and oncology at Southern Illinois University in Springfield. Mocharnuk testified in executive committee May 11 on behalf of the Simmons Cancer Institute and the American Cancer Society to push for equal insurance coverage for oral cancer treatment.

He says equal insurance coverage for oral cancer treatment is a question of doing the right thing. “Why should a drug be punished because of the route of administration?” he says.

Mocharnuk notes that while some insurance companies do not cover oral treatment, some charge a co-pay fee, where a patient can pay between 5 and 50 percent of the total cost of medication. Payments easily add up though when, for example, individuals have a 20 percent co-pay on an $8,000 medication.

“Then it becomes a choice between treating yourself or mortgaging the farm,” says Mocharnuk.

Mocharnuk says that the pill form of oral cancer treatment, compared with intravenous chemotherapy, is just as effective because the medication is “targeted,” and causes less side effects like hair loss and nausea in patients.

“We’re treating cancer here, we’re not treating headaches or high blood pressure,” he says.

Contact Holly Dillemuth at hdillemuth@illinoistimes.com.
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