Cancer treatment is not merely about survival. When every ounce of energy is devoted to healing, the next trip to the doctor’s office can be a grueling journey. Replacing that trip with a pill would provide more time with family instead of time spent in a patient waiting room. While focused on the bottom line, insurance companies don’t consider quality of life.
Tremendous progress has been made in treating cancer over the past decade. Unfortunately, insurance coverage for the most innovative cancer treatments has not kept pace. A substantial portion of cancer drugs are now given in pill form, rather than intravenously. These pills save patients frequent trips to the hospital, improving care and turn cancer into a manageable disease.
Drugs administered intravenously or infused are covered under medical benefit sections of insurance plans. Oral anti-cancer treatments are covered under pharmacy benefit sections. This means consumers are forced to pay higher out-of-pocket expenses for pills than for injections or IV infusion treatments.
As a cancer patient I was lucky. I had the luxury of an RN at home and a caring medical team. I was able to take a preloaded injection home and avoid a days worth of energy spent for a ten minute office visit the day after chemotherapy. Still, I lived in fear of what the insurance company might cover. When diagnosed with traditionally terminal cancer I feared my insurance carrier more than the diagnosis. The diagnosis meant losing control over my life. Would the insurance company prevent me from living as I saw fit? Their decisions ruled my life.
SB 961, already approved by the California State Senate and currently under debate in the State Assembly, seeks to change this imbalance. The legislation would ensure cancer patients are able to receive the appropriate medications for their illness without being subjected to exorbitantly high out-of-pocket co-pays on oral treatments.
This legislation can tackle two goals at once: help rein in unnecessary health care spending while ensuring cancer patients get access to the treatments they desperately need. We urge the members of the Assembly to vote yes on SB 961.