Cancer patients win big as governor signs patient access bills into law

By Staff

Cancer patients in Colorado scored a big win last week as Gov. Bill Ritter signed two bills into law that increase their access to anti-cancer therapies.

"Frequently we are prevented from using the best treatment or combination of treatments because we don't want the patient to be stuck with tens of thousands of dollars of medical costs due to lack of insurance coverage," said Wells Messersmith, M.D., co-leader of the University of Colorado Cancer Center's developmental therapeutics program. "Both of these bills are reasonable solutions to patient access to appropriate care."

House Bill 1202 requires insurance companies in Colorado to cover oral chemotherapy drugs for the same co-insurance or copay patients would pay for IV or injected drugs. House Bill 1355 requires insurance companies to cover the cost of anti-cancer drugs recognized by the U.S. Department of Health and Human Services (HHS) as effective against cancer regardless of the specific type of cancer the drug was initially approved to treat – so called "off label" use.

"Until these new laws go into effect, a patient's access to effective chemotherapy is often based on insurance coverage rather than what the doctor or even a clinical trial suggested would be the best treatment," said Messersmith, associate professor of medical oncology at the University of Colorado School of Medicine. "We could have two patients sitting next to each other in the infusion center getting different drugs for the same type of cancer based on insurance coverage. That isn't fair."

About half of all cancer drugs are used "off label" – the drug wasn't initially approved by FDA to treat a specific type of cancer that experts now agree it is effective against. Lists of acceptable drugs for specific cancers are maintained as "compendia." In that case, the drug is "compendia-listed" as effective against cancer types X, Y and Z, even if the drug manufacturer hasn't put the drug through the expensive process of changing the label via clinical trials and further FDA approval. HB 1355 requires insurance companies to cover drugs listed by HHS as effective and appropriate, rather than what's on the label.

HB 1202 solves another problem with access to care. Many anti-cancer treatments – and especially new targeted therapies – are developed as pills, rather than intravenous (IV)-delivered or injected drugs. Despite the fact that chemotherapy pills are as powerful as their infused or injected versions, let alone more convenient for patients to take, some insurance companies cover the drug only if it is given by IV.

Patients whose insurance companies don't cover oral chemotherapy "same as" face a trade-off: pay thousands of dollars for the pills, or have the insurance company pay for the IV version while they miss work and other activities for regular trips to an infusion center and risk losing quality of life because of an access port inserted beneath their skin.

Messersmith cites rectal patients as an example of people who will benefit from this new law.

"They have to come in for radiation therapy five days a week for five weeks, and they can either take their chemotherapy by swallowing a pill or by wearing an IV medicine pump during the workweek," he said. "Many patients who couldn't afford the pills because they weren't covered by their insurance company will now have much better quality of life when the pills are covered for the same cost to them as the infused drug. Moreover, when infusion costs and nursing care are factored into the equation for IV drugs, total treatment costs are often evened out between pills and IV drugs, but for patients the differences could be astronomical prior to this bill."

Messersmith said the new law will eliminate a two-tiered system where patients are penalized for taking oral chemotherapy.

"I view this as a big win for cancer patients in Colorado, and for their cancer doctors who have been stymied by a patient's lack of insurance coverage for the most effective, or most convenient, treatment," he said.