|By Elizabeth Simpson, The Virginian-Pilot, Norfolk, Va.|
Surgery to remove a baseball-size tumor from his head. A stem cell transplant at
When lab work showed the blood cancer's levels creeping up again in 2008, his doctor suggested a new oral chemotherapy drug called Revlimid.
The cost was a jaw-dropper:
"I thought, 'What? Are they trying to rob us?' " said Holt, 57, who lives in
Even with health insurance, his co-pay for the drug was going to be
Instead, he went with what his doctor said would be a good, but probably less effective, intravenous chemo option. He drove from
Because the IV procedure was performed in a doctor's office, his insurance covered almost the entire cost.
It's a dilemma that cancer patients across the country face as newer, and more expensive, oral medications come onto the market. Insurance plans cover IV chemotherapy as a medical benefit but consider oral med chemotherapy part of a patient's drug plan, which usually requires a higher co-pay.
So the more convenient, less invasive method often gets trumped because of cost.
"Do you want the 98 percent to help the 2 percent get more affordable meds?" he asked.
Kruger said that particularly during the past five years, research has led to oral meds that stem cancer growth. They're turning cancers into chronic diseases that can be managed for years through medication.
If more patients could afford the oral meds, Kruger said, it would reduce hospital costs as well as the amount of time patients lose from work. He said each of the group's 12 practices has one employee whose sole job is to link patients who can't afford their oral meds with organizations that can help them.
Parity bills are important to people with multiple myeloma because they often use several methods to combat it, according to
In some cases, IV chemo will work for a while but then stops being effective. At that point, an oral medication is usually critical in fighting the cancer.
"When one method stops working, they need to go back into the toolbox," Buzby said.
In Holt's case, the IV chemo worked for 2-1/2 years, but then his cancer levels began rising again. Last March, his doctor strongly recommended Revlimid.
Holt didn't have any good options, so his wife,
"Every relapse you think, 'Oh my God, I'm going to be a widow,' " Faye said. "And then another treatment comes along."
"People die because they can't afford it," he said.
He is thankful for the various treatments, as he's now a 13-year survivor, the longest in his support group. That's given him time to enjoy his two grandchildren and to cheer on his favorite team, the
He holds up the bottle of white capsules and says, "That's gold. I should sell it on the black market."
In 2006, she was diagnosed with colon cancer. She had IV chemo for six months, but it didn't work, so she tried another type of IV chemo drug for eight more weeks.
After that failed in 2007, her doctor recommended Xeloda, an oral med that costs
"I freaked out. The bills were starting to pile up," said Jones, who lives with her parents now because of her illness and finances. She looked into getting other supplemental insurance but the cost would have swallowed her entire disability check.
Her doctor's office wrote off most of its bill so she could afford the medication. In 2010, she discovered the
The foundation has been lobbying for passage of parity bills for chemo meds.
He said studies have shown that states that passed the parity legislation have not seen increases in premiums.
Jones has testified in
"With the IV drugs, you have more anemia and hair loss. You are sitting for hours in a chair, hooked up with an IV," said Jones, who said the veins in one of her arms can't even be used anymore. "With the oral meds, I'm able to take those at home. It's less time-consuming and less invasive."
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|Source:||McClatchy-Tribune Information Services|