New Law Requires Equal Insurance Coverage for Oral Chemotherapy
CHICAGO - July 27, 2011. Governor Pat Quinn today signed legislation to ensure health insurance benefit equality between oral and injectable cancer drugs, allowing cancer patients more affordable treatment options and protecting them from significantly high out-of-pocket costs. House Bill 1825 requires private health insurance plans that provide coverage for oral and intravenous chemotherapy to cover both at the same benefit level.
"Patients battling cancer shouldn't have to forgo potentially life-savings treatments because of costs," Governor Quinn said. "This legislation will provide more affordable coverage options, so that patients can choose the best, most appropriate therapy to fight their cancer."
Historically, chemotherapy drugs have been primarily administered intravenously. Today, many types of chemotherapy can be taken via a liquid, tablet or capsule, a less invasive therapy alternative. Oral chemotherapy is the only appropriate treatment for certain types of cancer, and can also provide an alternative for patients who have trouble responding to other treatments.
Many healthcare benefit plans have not changed to ensure patient access to oral chemotherapy, resulting in some cancer patients facing higher out-of-pocket costs simply because their treatment is dispensed orally rather than intravenously.
The disparity in coverage for oral treatments is also a factor in deployment of "smart drugs" in cancer treatment. Traditional radiation and chemotherapy are effective in killing cancerous cells, but also kill many healthy cells, weakening a patient's immune system. Smart drugs are delivered orally and designed to navigate the bloodstream with precision to stop the growth of cancer cells, often avoiding damage to healthy cells. While these regimens are often more costly up front, they may be able to significantly decrease the amount of therapy time, increase positive outcomes and reduce longer-term costs associated with traditional intravenous treatments.
Illinois joins a number of states that have enacted cancer drug parity laws including Connecticut, Colorado, Indiana, Iowa, Hawaii, Kansas, Minnesota, Oregon, Vermont, the District of Columbia, and New Mexico. Medicare recipients also receive this benefit for identical oral and intravenous chemotherapy drugs.
Sponsored by Rep. Ann Williams (D-Chicago) and Sen. Heather Steans (D-Chicago), HB 1825 passed the General Assembly unanimously and takes effect Jan. 1.
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