Senate Bill 1034 addresses parity of chemotherapy treatments under insurance

Posted at 11:02 AM, Feb 25, 2019
and last updated 2019-02-25 20:16:36-05

BOISE — A cancer diagnosis doesn’t care if it messes with your life plans.

"I have a family, I'm married, I have a grandchild," said cancer survivor Charles Seip, "you have these feelings of realizing how fragile life is."

Most hope their insurance does care. Senate Bill 1034 is being introduced Monday in the Idaho Statehouse to address how chemotherapy treatments are handled under insurance plans.

"There’s a much greater upfront out of pocket cost for a patient who would be receiving oral chemotherapy treatment as opposed to a patient who would be receiving treatment through an IV," said Senator Lori Den Hartog.

Sometimes, IV chemotherapy treatment isn’t possible.

“2001, went in for hernia surgery. Through a series of tests, I found out I had Chronic Myeloid Leukemia," said Seip.

This cancer is a chromosomal abnormality in bone marrow. Meaning, unlike other cancers, IV chemotherapy is ineffective. Charles has been battling this cancer, as well as its price tag, for nearly 19 years.

"The drug was just priced way out of pocket, I think it’s $12,000 a month," said Seip.

Under his BlueCross healthcare plan, he was receiving co-payment assistance and ACA help for the drug ’Sprycel.' Since oral chemotherapy is filed under insurance as a prescription benefit and not a hospital benefit, the money doesn’t stretch as far.

"My co-pay assistance ran out in 5 months of that year, and so without the co-pay assistance, I couldn’t receive the drug," said Seip.

It cost him five months without treatment before switching to a different brand of oral chemo, which his body didn’t respond to as well.

"I was suffering the side effects of it, but it's better to suffer side effects than it is to die," said Seip.

The complexities associated with insurance plans means this isn’t a straight-forward fix to the problem, but senator Hartog says the current rules don’t fit with the times.

“You know, no one wants to think about the costs associated when you’re faced with some of the most difficult decisions of your life," said Hartog. "Modern medicine is and has been advancing, and I think we just haven’t been able to keep up with the times under our current insurance plans.”

The Idaho Association of Health Plans declined to comment. BlueCross of Idaho gave a statement, saying "BlueCross of Idaho covers nearly every oncology medication in every drug class."