FlipFlopper
2011-11-17 18:12:04 UTC
"A 51-year-old mother of three who lives in Anne Arundel County, Md.,
received diagnoses of unrelated cancers of the brain and breast.
After she had surgery to remove the brain tumor, her doctors at Johns
Hopkins Hospital in Baltimore put her on six weeks of daily doses of
two pills of the chemotherapy drug Temodar.
"The medication cost $10,800. Her insurance company paid $2,000. Kate
said her provider told that if she’d taken the identical drug
intravenously, she wouldn’t have paid a dime."
==========
Maybe when winter weather thins out the OWS camps, the participants
might consider plopping down in front of the appropriate BigPharma and
BigMedical insurers headquarters to protest egregious costs of cancer
medications.
Personally, I sort of believe that these giant members of the even
bigger Cancer Empire are keeping more effective medications secret,
because the worst that could befall these monoliths would be the
release of meds that actually cure or prevent cancer(s).
Like the millionaire CEOs of these firms would tell us, "It's all
about treatment, baby!"
===========
"Insurance loophole on cancer treatments sticks patients with extreme
cost"
By Robert McCartney
November 16, 2011
NOBODY LIKES PAYING a lot for health insurance, but at least it
provides peace of mind. Even while we grumble about steadily rising
deductibles and co-pays, we figure if we get really sick — with
cancer, say — then insurance will handle the bills.
It’s not a safe assumption. A growing number of cancer patients,
including in our region, are being stuck with exorbitant bills for
chemotherapy drugs because of a common insurance policy loophole.
Basically, insurance companies often cover just a fraction of the cost
of a needed cancer medication if it’s taken in the form of pills. The
companies reimburse the full price only if the patient receives the
drug intravenously.
That’s a problem because many new cancer drugs are supposed to be
taken orally or are available only in pill form. In some cases, the
same drug is covered by insurance if taken via injection and not
covered if it’s taken orally. The difference in out-of-pocket cost to
the patient can run in the thousands of dollars a month.
Cancer doctors, hospitals and patient advocacy groups decry the
discrepancy as outrageous. There’s a nationwide campaign to eliminate
it, including a bill in Congress. The District and 13 states have
passed laws in the past three years to require parity between oral and
intravenous chemotherapy drugs. The discrepancy has been fixed for
Medicare.
But some insurance companies and budget-conscious legislators are
resisting change. The disparity still exists in Virginia and Maryland,
and it’s uncertain whether those states will eliminate the problem any
time soon.
“It’s a dollar issue,” said Paul Celano, president of the Maryland
Society of Clinical Oncology. “Everyone agrees in principle that
patients should be able to get their cancer care, and there shouldn’t
be this insurance dodge that they’re charged a substantially different
rate because of the type of medication.”
In Virginia, a parity bill has been introduced in the General Assembly
session but died in committee. A Maryland bill was withdrawn because
of concerns it would cost the state millions of dollars to reform
coverage for state employees.
One victim of Maryland’s failure to act is Kate S., a 51-year-old
mother of three who lives in Anne Arundel County. Since August, she
has received diagnoses of unrelated cancers of the brain and breast.
She spoke on the condition that I not publish her surname, for
privacy’s sake.
After Kate had surgery to remove the brain tumor, her doctors at Johns
Hopkins Hospital in Baltimore put her on six weeks of daily doses of
two pills of the chemotherapy drug Temodar.
The medication cost $10,800. Her insurance company paid $2,000. Kate
said her provider told that if she’d taken the identical drug
intravenously, she wouldn’t have paid a dime.
“I was really shocked by this, and they told me it was very common,”
Kate said. She didn’t learn about the discrepancy until two weeks into
the treatment.
“It wasn’t presented to me as an option to do it intravenously. They
told me, this is what you do,” Kate said.
Soon she’ll begin a second round of chemotherapy, for six months. She
estimates that will cost her $15,000 unless she opts for intravenous
treatment. Her doctors recommend against that, and it would be less
pleasant and convenient. She’d have to go regularly to a clinic to
spend hours sitting with a needle in her arm, rather than swallowing
pills at home.
Kate said that the cost is a burden but that she has savings to cover
it. It would be severe for others with less money, she said.
“This is a rough time for a lot of people. They may have to make a
decision to go in for [intravenous] infusions just because they don’t
want to go into debt,” Kate said.
That’s just the kind of person that led state Sen. Jamie B. Raskin (D-
Montgomery) to co-sponsor a parity bill in Annapolis.
A colon cancer survivor, Raskin heard complaints about the oral-
intravenous discrepancy while receiving chemotherapy in clinics in
Annapolis and Silver Spring.
“Sitting in the rooms where chemo is administered, I met people who
would have preferred to be using the pill form but whose insurance
plans weren’t covering it,” Raskin said. He plans to resubmit a bill
in the session beginning in January.
Cancer patients have enough worries without anxiety over whether they
can afford the drug recommended by their doctor. Because any of us is
vulnerable to the disease, parity would add peace of mind for
everyone.
http://www.washingtonpost.com/local/insurance-loophole-on-pill-vs-iv-cancer-drugs-sticks-patients-with-extreme-cost/2011/11/16/gIQApJyMSN_story.html
received diagnoses of unrelated cancers of the brain and breast.
After she had surgery to remove the brain tumor, her doctors at Johns
Hopkins Hospital in Baltimore put her on six weeks of daily doses of
two pills of the chemotherapy drug Temodar.
"The medication cost $10,800. Her insurance company paid $2,000. Kate
said her provider told that if she’d taken the identical drug
intravenously, she wouldn’t have paid a dime."
==========
Maybe when winter weather thins out the OWS camps, the participants
might consider plopping down in front of the appropriate BigPharma and
BigMedical insurers headquarters to protest egregious costs of cancer
medications.
Personally, I sort of believe that these giant members of the even
bigger Cancer Empire are keeping more effective medications secret,
because the worst that could befall these monoliths would be the
release of meds that actually cure or prevent cancer(s).
Like the millionaire CEOs of these firms would tell us, "It's all
about treatment, baby!"
===========
"Insurance loophole on cancer treatments sticks patients with extreme
cost"
By Robert McCartney
November 16, 2011
NOBODY LIKES PAYING a lot for health insurance, but at least it
provides peace of mind. Even while we grumble about steadily rising
deductibles and co-pays, we figure if we get really sick — with
cancer, say — then insurance will handle the bills.
It’s not a safe assumption. A growing number of cancer patients,
including in our region, are being stuck with exorbitant bills for
chemotherapy drugs because of a common insurance policy loophole.
Basically, insurance companies often cover just a fraction of the cost
of a needed cancer medication if it’s taken in the form of pills. The
companies reimburse the full price only if the patient receives the
drug intravenously.
That’s a problem because many new cancer drugs are supposed to be
taken orally or are available only in pill form. In some cases, the
same drug is covered by insurance if taken via injection and not
covered if it’s taken orally. The difference in out-of-pocket cost to
the patient can run in the thousands of dollars a month.
Cancer doctors, hospitals and patient advocacy groups decry the
discrepancy as outrageous. There’s a nationwide campaign to eliminate
it, including a bill in Congress. The District and 13 states have
passed laws in the past three years to require parity between oral and
intravenous chemotherapy drugs. The discrepancy has been fixed for
Medicare.
But some insurance companies and budget-conscious legislators are
resisting change. The disparity still exists in Virginia and Maryland,
and it’s uncertain whether those states will eliminate the problem any
time soon.
“It’s a dollar issue,” said Paul Celano, president of the Maryland
Society of Clinical Oncology. “Everyone agrees in principle that
patients should be able to get their cancer care, and there shouldn’t
be this insurance dodge that they’re charged a substantially different
rate because of the type of medication.”
In Virginia, a parity bill has been introduced in the General Assembly
session but died in committee. A Maryland bill was withdrawn because
of concerns it would cost the state millions of dollars to reform
coverage for state employees.
One victim of Maryland’s failure to act is Kate S., a 51-year-old
mother of three who lives in Anne Arundel County. Since August, she
has received diagnoses of unrelated cancers of the brain and breast.
She spoke on the condition that I not publish her surname, for
privacy’s sake.
After Kate had surgery to remove the brain tumor, her doctors at Johns
Hopkins Hospital in Baltimore put her on six weeks of daily doses of
two pills of the chemotherapy drug Temodar.
The medication cost $10,800. Her insurance company paid $2,000. Kate
said her provider told that if she’d taken the identical drug
intravenously, she wouldn’t have paid a dime.
“I was really shocked by this, and they told me it was very common,”
Kate said. She didn’t learn about the discrepancy until two weeks into
the treatment.
“It wasn’t presented to me as an option to do it intravenously. They
told me, this is what you do,” Kate said.
Soon she’ll begin a second round of chemotherapy, for six months. She
estimates that will cost her $15,000 unless she opts for intravenous
treatment. Her doctors recommend against that, and it would be less
pleasant and convenient. She’d have to go regularly to a clinic to
spend hours sitting with a needle in her arm, rather than swallowing
pills at home.
Kate said that the cost is a burden but that she has savings to cover
it. It would be severe for others with less money, she said.
“This is a rough time for a lot of people. They may have to make a
decision to go in for [intravenous] infusions just because they don’t
want to go into debt,” Kate said.
That’s just the kind of person that led state Sen. Jamie B. Raskin (D-
Montgomery) to co-sponsor a parity bill in Annapolis.
A colon cancer survivor, Raskin heard complaints about the oral-
intravenous discrepancy while receiving chemotherapy in clinics in
Annapolis and Silver Spring.
“Sitting in the rooms where chemo is administered, I met people who
would have preferred to be using the pill form but whose insurance
plans weren’t covering it,” Raskin said. He plans to resubmit a bill
in the session beginning in January.
Cancer patients have enough worries without anxiety over whether they
can afford the drug recommended by their doctor. Because any of us is
vulnerable to the disease, parity would add peace of mind for
everyone.
http://www.washingtonpost.com/local/insurance-loophole-on-pill-vs-iv-cancer-drugs-sticks-patients-with-extreme-cost/2011/11/16/gIQApJyMSN_story.html