On bill requiring oral cancer med coverage, pharma asked to shoulder some of the burden

TRENTON – After hearing testimony from cancer survivors, family members of cancer victims, and health insurance lobbyists, the Assembly Health and Senior Services Committee unanimously approved A2666, a bipartisan bill that would require health insurers to cover oral cancer drugs on the same basis as intravenous cancer medications.

The oral drugs are becoming preferred alternatives to IV treatments because they do not require in-facility patient care, although the costly meds are not currently covered by insurers to nearly the same degree for many consumers.

Chairman Herb Conaway (D-7), of Delanco, said the cost to the insurers could range from $1.30 to 50 cents per member annually, according to studies.

“We’re not talking about huge costs here,” he said, “It would be ideal, certainly, if folks did not have these increased cost burdens (but the question is,) should the government try to help in that situation or not?…It seems to me that the costs are on the small side.”

The bill would require health insurance carriers (hospital, medical, and health service corporations; individual, small employer, and larger group commercial insurers; and health maintenance organizations); the State Health Benefits Program (SHBP), and the School Employees’ Health Benefits Program (SEHBP) to provide coverage for expenses for prescribed, orally-administered anticancer medications under the same terms and conditions as the policy or contract provides for intravenously administered or injected cancer medications.

The bill also requires carriers, SHBP, and SEHBP to provide coverage for expenses for medically necessary medications, such as medications that maintain red or white cell counts and treat nausea, that support the orally administered anticancer medications, under the same terms and conditions as the policy or contract provides for intravenously administered or injected cancer medications.

Christine Stearns, N.J. Business and Industry Association vice president, provided a “perspective from the employer community,” and said, “This legislation, as a mandate, impacts mostly small employers…Of course, the cost of (health) coverage (in general) is becoming prohibitive for many employers.”

She said last year, health care costs for employers spiked between 20 to 30 percent; this year, another 10 to 20 percent hike. She said because of this over 130,000 people are no longer being covered for health care in the small employer market.

Conaway asked whether cancer patients should have access to “the most appropriate” care. Stearns said they should, but the cost to employers also needs to be addressed, especially with costs shooting upwards. “I don’t see anything that’s going to stop that,” she said.

Another health care lobbyist, Sarah McLallen, vice president of the Association of Health Plans, offered several amendments, and said the pharmaceutical industry should also be examined in this regard to help find savings.

The recommendations included limiting co-insurance levels for some or capping out-of-pocket costs.

But she said, “Pharmaceutical companies also have a responsibility for this debate,” recommending “incentivizing reasonable pharmaceutical pricing for these drugs.”

She also said a “cost-sharing relief fund,” to defray costs of needy patients, could be established. Conaway said this could be examined.

Co-sponsor Assemblywoman Nancy Munoz (R-21), of Summit, said she’s usually not in favor of measures that increase costs to the state, but is making an exception for this bill.

She saw cancer treatments first-hand at Memorial Sloan-Kettering, she said, spent 35 years as a nurse, and helped her mother during a successful fight against breast cancer.

“It’s not just the cost of the pill,” she said. “It’s the cost to the patient.”

Current cost-drivers that make the oral drugs more expensive than the IV drugs, she said, are likely research and development-based, drivers that would contract over time. She expects that oral treatments will be just as costly, or less costly, than IV methods in coming years.

On bill requiring oral cancer med coverage,  pharma asked to shoulder some of the burden