Raleigh, N.C. — A proposal to require health insurers to offer the same coverage for oral and intravenous cancer treatments has passed the state House, but not without an amendment that changes the terms.
The original version of House Bill 609, the "NC Cancer Treatment Fairness Act," said insurers who offer coverage for chemotherapy can't charge patients higher out-of-pocket fees for newer, more expensive oral drugs than for older, less expensive IV formularies, many of which have more severe side-effects and are less effective.
"The method in which the drug or the treatment is delivered needs to be treated with parity," said sponsor Rep. David Lewis, R-Harnett. "That means it needs to cost the same."
But other lawmakers said the proposal could force insurers to offer the expensive drugs for free.
"The cost of health care is very complex. Insurance companies negotiate with hospitals for every drug, every procedure," said Rep. Verla Insko, D-Orange.
Insko said hospitals, too, charge wildly divergent rates for similar procedures. Asking an insurer to figure out what a given patient might have to pay out of pocket for IV treatment at any covered provider would be impossible.
"Because they can’t establish a uniform co-pay, they have a co-pay of zero," she said. "In other states where this has passed, that’s exactly what’s happened. They don’t know what to tell the pharmacist to charge, so they charge zero."
Insko warned that would drive up insurance costs for everyone.
Rep. Sarah Stevens, R-Surry, amended the bill to set a $300 out-of-pocket maximum per filled prescription of an oral cancer drug.
"It is better and it doesn’t give the drug away for free," she said. "Insurers can still charge less."
Rep. Tom Murry, R-Wake, a pharmacist, called the amendment "a reasonable approach."
Rep. Jim Fulghum, R-Wake, a doctor, agreed. "It would be highly unusual to prescribe more than one oral anti-cancer drug at a time," Fulghum said. "You get sick enough with one."
Despite Lewis' opposition, the amendment was approved 80-36, and the bill itself was given final approval by a vote of 112-5. It now moves to the Senate.