Raleigh, N.C. — The state House has voted once again to require health insurance companies to cover oral chemotherapy drugs in the same way that they cover injected or IV-administered chemotherapy protocols.
House Bill 206, dubbed the Cancer Treatment Fairness Act, is similar to legislation that passed the House by overwhelming margins in each of the past two sessions. However, the proposal has never been granted a committee hearing in the Senate, much less a vote.
Under current law, health insurance companies charge a flat co-pay per procedure for chemotherapy that's administered via IV or injected. That was the standard protocol up until recent years. Many of the newer therapies being developed are oral drugs – a pill the patient takes, rather than a procedure.
At present, many insurance companies classify oral chemotherapy as a prescription drug, rather than a treatment, so it's subject to cost-sharing rules for the former rather than the latter. The legislation would require insurance companies to treat all types of chemotherapy equally in terms of coverage, regardless of how they're administered.
Supporters of the measure, including the American Cancer Society Cancer Action Network, say some companies charge oral chemo patients as much as half the drug's price. Some of the drugs can cost tens of thousands of dollars, so that hefty prescription co-pay can mean the difference between getting the preferred chemo treatment or not.
"This is about parity," said sponsor Rep. David Lewis, R-Harnett. "There is no good reason that a person should have to choose to take an IV drug over a more effective oral drug simply because of a co-pay differential."
Insurance companies warn the change could lead to higher plan costs and premiums, a concern echoed by opponents of the measure on the House floor Monday night.
"This bill actually eliminates a market force that actually holds the cost down, and that’s the ability for insurance companies to negotiate," said Rep. Verla Insko, D-Orange. "There won’t be any negotiation under this bill."
“It’s going to make prices go up for everybody,” argued Rep. Dana Bumgardner, R-Gaston. “It’s a small segment of the market, but it’s going to have a huge effect.”
"This is a drug manufacturer's bill," said Rep. Jeff Collins, R-Nash, who tried unsuccessfully to have the bill re-referred to his House Insurance Committee. "This is not about cancer. This is not about the patients. This is about money."
Forty-two other states and the District of Columbia have passed legislation to require insurers to offer more coverage for oral chemotherapy. According to the measure’s supporters, none of those states has seen a significant increase in premiums as a result.
Rep. Nelson Dollar, R-Wake, told the House that North Carolina is the national leader for clinical trials.
Conceding that opponents of the measure had valid points, Dollar asked House lawmakers to consider "one basic question."
"If it was your mother, if it was your mom, and she had one of these rare cancers that require these types of very intense treatments, would you want to provide for her the choice to have the best treatment?" Dollar asked.
The vote was 90-22. The measure now moves to the Senate.