Raleigh, N.C. — State House lawmakers tentatively approved a proposal Wednesday that would ban insurers from charging patients more for oral chemotherapy than for intravenous drug treatments.
The vote came on the heels of a lengthy, passionate and sometimes strange debate, with lawmakers on opposite sides of the political spectrum forming unlikely alliances for and against the proposal.
House Bill 609, the "NC Cancer Treatment Fairness Act," says insurers who offer coverage for chemotherapy can't charge patients higher out-of-pocket co-insurance fees for newer, more expensive oral formulations than for older, less expensive IV formularies, many of which have more severe side-effects and less efficacy.
"If a doctor decides that if a person’s illness can be treated via a pill or some other kind of medicine instead of having to go to a treatment center site for treatment through an IV injection for however long that takes, the out-of-pocket cost can’t be any higher than if they did," said sponsor Rep. David Lewis, R-Harnett. "The method in which the drug or the treatment is delivered needs to be treated with parity. That means it needs to cost the same."
Rep. Sarah Stevens, R-Surry, said because of differences in the way medical insurers and pharmaceutical insurers bill, some have been forced to offer oral chemo drugs for free in states where similar bills have been introduced.
She offered an amendment that would instead have capped the patient's monthly out-of-pocket expenses at $500 for oral chemo.
"We're doing this for cancer, what happens next?" she asked.
Rep Verla Insko, D-Orange, agreed with Stevens. "There are many other specialty drugs that cost a lot,” she said, warning that their makers would all likely expect the same treatment from lawmakers.
"Some of these drugs cost $10,000 per pill," Insko said. "The insurance companies will not absorb that."
Insko said the state's largest insurer, Blue Cross Blue Shield of North Carolina, has agreed to accept the $500 per month co-insurance cap for a variety of specialty drugs. "I think it would be not good policy for this bill to pass with no co-pay."
But Lewis said that cap would be too high – much higher than in any of the 24 other states that have approved similar bills.
"Studies show – it’s ironic – the $500 amount is the point where over a quarter of the people who are receiving treatment decide they can’t afford it. So, they don’t get the treatment they need," he said.
"We know that what we’re really seeing, in part, is a contest between Blue Cross and the pharmaceutical companies," said Rep. Rick Glazier, D-Cumberland. "The people being caught in the crossfire are the patients. I’m going to side with the patients. There are only about 100 of them."
The amendment was withdrawn for more work, but the bill's critics weren't finished.
"We’re telling health insurance companies what they’re going to do in North Carolina," said Rep. Jeff Collins, R-Nash, a former insurance salesman. "Every time we pass mandates, the price goes up."
But its proponents weren't finished, either.
Rep. Jim Fulghum, R-Wake, said he "agonized" over the bill but came out in favor of it.
“The insurance carriers treat (medicine and pharmaceutical coverage) as two separate benefits. I think that’s an artificial split. It should be treated as a disease benefit,” said Fulghum, a physician. “The disease benefit should be what the patient sees, not this slice-and-dice routine.”
Reps. Pat McElraft, R-Carteret, and Bobbie Richardson, D-Franklin, spoke from family and personal experience about the higher quality of life that oral chemo drugs can provide compared to IV treatment.
"This is about parity for patients," said Rep Alma Adams, D-Guilford.
Collins warned again that the bill could raise insurance rates on "people who are trying to make a living."
"I wish everything could be free. I wish we could pay for every bad thing that happens to everybody," Collins said. "But we just can’t afford to do that."
An attempt by the bill's opponents to send it back to the Insurance Committee for a second time failed on a vote of 86-27.
The bill passed its first reading, 87-27, and is scheduled for a final House vote Thursday.