National Patient Advocate Foundation Responds to N.C. State House Approval of Flawed Cancer Treatment Fairness Bill

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RALEIGH, N.C., May 16, 2013 /PRNewswire-USNewswire/ -- Today, the National Patient Advocate Foundationacknowledges that the North CarolinaHouse of Representatives recently approved a bill that would prohibit insurers who offer coverage for chemotherapy from charging patients higher out-of-pocket fees for newer, more expensive oral anti-cancer drugs than for IV formularies, many of which have more severe side-effects. However, the bill was amended to include a maximum out-of-pocket limit of $300, which will continue to be a barrier to patients with cancer and in need of essential life saving medications. NPAF urges North Carolina's senators to approve legislation that would require insurers to offer parity in the cost of anti-cancer medications by removing the $300 requirement.

"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."

Despite the increasing availability of oral chemotherapy drugs providing greater comfort and convenience for cancer patients, many health insurance plans often cover oral chemotherapy drugs under prescription drug coverage, which is generally not financially feasible as coverage for IV drugs. Many cancer patients opt to undergo inconvenient and physically difficult IV treatments at a facility because they cannot afford orally administered chemotherapy drugs. Though NPAF is in support of the N.C. Cancer Treatment Fairness Act as originally written, the organization does not support amended language that changes the original bill and sets a $300 out-of-pocket maximum per filled prescription of an oral cancer drug in addition to delaying the implementation date to January, 2015. North Carolina's senators now have an opportunity to correct the problematic amendment language.

"This out of pocket maximum is simply too high," said NPAF President Nancy Davenport-Ellis. "Many of these patients in need of life saving medications are dependent on more than one particular drug to treat their illness. So the new language in the bill requiring an out-of-pocket co-pay of $300 actually escalates very quickly and dramatically. This creates a huge financial burden on families. We know from the data we've seen, that at this high of a rate, patients are likely to abandon these medications altogether. We appreciate the efforts of Representative Lewis to bring legislation forward that will make a huge difference in the lives of patients. However, the new language in the bill defeats his intent and undermines this otherwise good legislation. North Carolina's senators now have an opportunity to do the right thing for patients by restoring this bill to its original language."

The median household income in North Carolina from 2007 – 2011 was $46,291 according to the US Census Bureau. From the Patient Advocate Foundation Patient Data Analysis Report (http://www.patientadvocate.org/about.php?p=898) in 2012 however, the majority of the commercially insured patients PAF served had a household income of $12,000 - $45,000 (Patient Advocate Foundation; Patient Data Analysis Report 2012, p. 56). This data also shows that a large majority of these patients have annual household incomes of less than $35,000. In North Carolina last year, 158,982 patients reached out to PAF for information and assistance. Of those, 3,457 were assisted by PAF case management services, which represents 3.17% of the organization's overall case management work load during 2012 (Patient Advocate Foundation; Patient Data Analysis Report 2012, p. 96). Also important to point out is that in 2012, 38.8% of the patients who contacted PAF reported difficulty in affording the out-of-pocket costs of their essential medications (Patient Advocate Foundation; Patient Data Analysis Report 2012, p. 144).

According to a Prime Therapeutics' study, patients with an out-of-pocket cost greater than $200 per month were at least three times more likely to not fill their prescription than those with out-of-pocket costs of $100 or less per month. An Avalere Health study also found that almost 10% of patients choose not to fill their initial prescriptions for oral anti-cancer medications due to the high rates of cost-sharing.