Committee approves equal coverage for oral anti-cancer meds

TRENTON – The Senate Budget Committee approved a bipartisan bill that would require health insurers to cover oral cancer drugs at the same level as intravenous cancer medications. Objections were heard from business advocates who argued that a state mandate could jeopardize prescription coverage plans currently in place.

Chairman Paul Sarlo, (D-36), of Wood-Ridge, said, “There’s another school of thought that this is just equalization.”

Several stakeholders who spoke, including some lawmakers, asked that the bill be reviewed by the state Mandated Healthcare Advisory Commission. Sarlo agreed, but said he was overruled by state Sen. President Steve Sweeney, (D-3), of West Deptford, who asked that the bill be moved in committee without commission review.

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

Ward Sanders, president of the N.J. Association of Health Plans, said the bill is “targeted at” two entities, the insurance industry and the state, a significant provider of health insurance. “We believe that this bill will add significant cost to the state,” he said, “and also the insurers.”

Also opposed to the bill are the N.J. Business and Industry Association, which warns that the measure could place a great financial burden on employers who have to provide health insurance for their workers, and the N.J Chamber of Commerce.

NJBIA’s Christine Stearns said the higher costs for prescriptions – on top of 10 percent to 20 percent annual premium increases – could lead employers to drop prescription coverage altogether or shift to a co-insurance program.

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 anti-cancer 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 anti-cancer medications, under the same terms and conditions as the policy or contract provides for intravenously administered or injected cancer medications.

The bill passed, 10-1, with only state Sen. Mike Doherty, (R-23), of Washington Township, opposed. He said the bill undercuts ongoing negotiations between insurance providers and the pharmaceutical industry that could render moot this law. Committee approves equal coverage for oral anti-cancer meds