Discussion:
NEED CHEMO FOR CANCER? Choose Intravenous, NOT Pills! Or You'll Be Real Sorry!
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FlipFlopper
2011-11-17 18:12:04 UTC
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"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
BruceS
2011-11-18 14:56:57 UTC
Permalink
<snip..read prev post for content>

Thanks for posting that. I'll be interested to see what arguments
anyone will have about this. I have to wonder if that's part of what
was going on with me, when I was prescribed an oral anti-nausea drug
and the insurance company balked. They reversed, and I got my med,
but only after days of severe nausea.

I'd just about given up on alt.support.cancer having any content other
than trolls, spammers, and kooks.
Tom Cular
2011-12-03 23:43:16 UTC
Permalink
Post by BruceS
<snip..read prev post for content>
Thanks for posting that. I'll be interested to see what arguments
anyone will have about this. I have to wonder if that's part of what
was going on with me, when I was prescribed an oral anti-nausea drug
and the insurance company balked. They reversed, and I got my med,
but only after days of severe nausea.
My wife has been receiving IV chemo since June along with IV anti naseua
medication while she is there. She also has oral anti nausea meds for use at
home, between chemo sessions. No problems with the ins. co. BC/BS of NJ
matt weber
2011-12-04 18:26:24 UTC
Permalink
On Sat, 3 Dec 2011 18:43:16 -0500, "Tom Cular"
Post by Tom Cular
Post by BruceS
<snip..read prev post for content>
Thanks for posting that. I'll be interested to see what arguments
anyone will have about this. I have to wonder if that's part of what
was going on with me, when I was prescribed an oral anti-nausea drug
and the insurance company balked. They reversed, and I got my med,
but only after days of severe nausea.
My wife has been receiving IV chemo since June along with IV anti naseua
medication while she is there. She also has oral anti nausea meds for use at
home, between chemo sessions. No problems with the ins. co. BC/BS of NJ
The issue isn't quite as simple as it may appear. What you often run
into is that the most expensive anti nausea meds (the 5HT3 blockers)
often require pre-authorization or 'step-therapy'. By contrast the low
cost drugs (haloperidol, compazine) etc do not require
pre-authorization. There literally a couple of orders of magnitude
difference between generic compazine, and brand name 5HT3 blockers.

While it is certainly true that the 5HT3 blockers can be more
effective, the reality is a very substantial portion of the patient
population could be successfully treated with much lower cost drugs.
Let me assure that there isn't a 2 order of magnitude difference in
the effectiveness of the two classes of drugs, it is more like 35%
versus 70%.

Just about all insurance companies will actually pay for the 5HT3
blockers, but often require that you try one of the low cost
alternative first.

The willingness of utilize the most expensive product right 'out of
the gate' is one of the things that drives US health care costs to be
roughly twice as high on a per capita basis than the 2nd most
expensive country in the Industrialized world. Cost effectiveness is
simply not part of the US health care equation.
BruceS
2011-12-05 02:57:30 UTC
Permalink
Post by matt weber
On Sat, 3 Dec 2011 18:43:16 -0500, "Tom Cular"
Post by Tom Cular
Post by BruceS
<snip..read prev post for content>
Thanks for posting that.  I'll be interested to see what arguments
anyone will have about this.  I have to wonder if that's part of what
was going on with me, when I was prescribed an oral anti-nausea drug
and the insurance company balked.  They reversed, and I got my med,
but only after days of severe nausea.
My wife has been receiving IV chemo since June along with IV anti naseua
medication while she is there. She also has oral anti nausea meds for use at
home, between chemo sessions. No problems with the ins. co. BC/BS of NJ
The issue isn't quite as simple as it may appear. What you often run
into is that the most expensive anti nausea meds (the 5HT3 blockers)
often require pre-authorization or 'step-therapy'. By contrast the low
cost drugs (haloperidol, compazine) etc do not require
pre-authorization. There literally a couple of orders of magnitude
difference between generic compazine, and brand name 5HT3 blockers.
 While it is certainly true that the 5HT3 blockers can be more
effective, the reality is a very substantial portion of the patient
population could be successfully treated with much lower cost drugs.
Let me assure that there isn't a 2 order of magnitude difference in
the effectiveness of the two classes of drugs, it is more like 35%
versus 70%.
Just about all insurance companies will actually pay for the 5HT3
blockers, but often require that you try one of the low cost
alternative first.
The willingness of utilize the most expensive product right 'out of
the gate' is one of the things that drives US health care costs to be
roughly twice as high on a per capita basis than the 2nd most
expensive country in the Industrialized world. Cost effectiveness is
simply not part of the US health care equation.
If "Emend" is a 5HT3 blocker, and compazine is comparable to
prochlorperazine, then my experience was that the former was a couple
orders of magnitude more effective. I'm sure you're right that most
patients are treatable with the less expensive meds. In a lot of
cases, cheap generic meds do everything that's required, and I suspect
that drug costs could be greatly reduced if all doctors were good
about trying the cheap stuff first. My gp does that, and I've been
quite happy with the results. However, with the anti-nausea drugs,
I'd already been using the less expensive stuff, and it was definitely
not doing the trick. See elsethread for the most probably cause, and
why a cheaper treatment was likely better, but we didn't know that
part in time. One of the things to keep in mind with drugs is that a
given drug interacts differently with different people. I trust my
doctors to find the most appropriate treatment, and I follow their
advice for the most part. When the insurance company gets in the
process and bureaucrats start making what are essentially medical
decisions, it infuriates me. I'd like to see them criminally charged,
with either malpractice (if the bureaucrat in question has any medical
degree) or more likely with practicing medicine without a license.
They need to accept the recommendations of the licensed doctors who
actually treat the patient.

I know; tl dr.

BruceS
2011-12-05 02:49:10 UTC
Permalink
Post by Tom Cular
Post by BruceS
<snip..read prev post for content>
Thanks for posting that.  I'll be interested to see what arguments
anyone will have about this.  I have to wonder if that's part of what
was going on with me, when I was prescribed an oral anti-nausea drug
and the insurance company balked.  They reversed, and I got my med,
but only after days of severe nausea.
My wife has been receiving IV chemo since June along with IV anti naseua
medication while she is there. She also has oral anti nausea meds for use at
home, between chemo sessions. No problems with the ins. co. BC/BS of NJ
I was doing fine with the chemo and anti-nausea drugs I got IV. My
onc said I was handling them much better than expected, and he was
very pleased with my progress. My problems started when the nurse
administrating my drugs asked me how I had been doing, re nausea,
etc. I said I'd been doing very well, and she decided that meant I
didn't need my IV anti-nausea drug. I didn't realise this at the
time, and only later made sense of a comment from her (mainly because
my wife was there) meaning she'd skip the anti-nausea drug, despite it
being prescribed by my doctor. This was the same nurse who was always
nervous about hurting the patient, so she pushed in the port needle
tentatively, maximizing discomfort. I much preferred a different
nurse, who slapped in the needle so fast it was hardly noticeable.
Anyway, without the IV anti-nausea drug, I was horribly nauseous.
That nurse just didn't understand how these things work. I'd been
doing well *because* of the drugs---that didn't mean I didn't need
them! I also had an oral anti-nausea drug (something like
prochlorperazine) and ate ginger in various forms to combat the low-
level nausea I had much of the time. The IV stuff was just the big
guns, so to speak, and without it I was trying to repel the Normandy
invasion with a .22 and a couple of air rifles.

If you can be present while your wife gets her drugs, I suggest you
look out for such behavior, and be sure the nurse doesn't countermand
the doctor's orders. I hope she does very well with her treatment.
Despite a couple of bad points, mine went very well, and I really
don't have much to complain about. I used to have BC/BS (AL), and it
was outstanding, but it's been a while. I hope they're as good now.
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