hand with pills
People who got insurance through the health law were significantly more likely to get prescription medications than they were before. Photo credit Okko Pyykkö, flickr creative commons

After long discussions in committee and on the floor of the House of Representatives, a bill to lower the cost of oral cancer medications gets a vote.

By Rose Hoban

A bill aimed at reducing the cost burden for people with cancer who take oral medications made it through a vote on the floor of the state House of Representatives Thursday afternoon, getting it one step closer to law.

Statewide, the Medication Assistance Program gave uninsured North Carolinians access to about $100 million in free medications last year. Photo courtesy of AnoLobb, Flickr Creative Commons
Photo credit, anolobb, flickr creative commons

Patients receiving cancer chemotherapy traditionally get their treatments via intravenous infusions or injections in their doctors’ offices. But with new medications that are administered orally, patients don’t need to go to a doctor’s office.

But they’re often subject to sticker shock when they pick up their medications, which can run in the hundreds, if not thousands, of dollars per dose.

What this bill does is seek to provide parity in the way that plans that provide this coverage actually get the delivery of the medicine to the one that’s sick,” said bill sponsor Rep. David Lewis (R-Dunn) during a House Insurance Committee meeting on Tuesday. “It doesn’t require plans to add stuff.”

He argued that the bill was not a mandate – that it only requires that prices for oral drugs be “no less favorable” than those negotiated for IV treatment.

Though the bill seemed like an easy, feel-good vote, it both elicited emotional support and raised objections from both sides of the aisle.

Rep. Robert Brawley (R-Matthews) spoke of losing younger men in his family to cancer.

And during floor debate Thursday night, the voice of Rep. Pat McElraft (R-Emerald Isle) cracked as she talked of her brother’s struggle with brain cancer.

“I saw the costs for those hospital stays for the IV therapy, and believe me, they were very, very expensive to his insurance company,” she said.

McElraft contrasted that with the experience of a friend who was successfully treated with an oral drug for her cancer.

“She went through that, did not lose any hair, had a wonderful cancer treatment, and has now been cancer free,” she said. “The quality of life that she had, compared to what my younger brother had, I can’t put a dollar value on that.”

“The cost of health care is very complex, and insurance companies negotiate with hospitals for every drug, every procedure,” said Chapel Hill Democrat Verla Insko, a former hospital administrator. “And they’re all different, depending on the negotiations.”

Insko said that in states where bills similar to this one have passed, insurers have had trouble determining what the parity price would be.

Rep. Sarah Stevens, (R-Mt Airy)
Rep. Sarah Stevens, (R-Mt Airy)

“You can go to one hospital and the price is $3,486 … another hospital it would be $15,000, and if you go to an independent physician’s office it may be $50,” she said.

Insko argued that in other states, pharmacists and insurers, unable to determine the so-called parity price, have simply charged nothing.

“And the insurance companies would not absorb this cost; they’d transfer the cost to other users or reduce coverage in other ways,” she said.

But Insko said she supported the idea the bill was trying to address.

“It’s really good for the patient,” she said of the bill.

Representatives debated the bill for close to an hour Wednesday evening and came back to it Thursday afternoon for a final vote. Insko then joined with Republican Sarah Stevens (R-Mt Airy) to offer an amendment on the House floor that would cap patients’ monthly out-of-pocket expenses for oral chemotherapy at $300 per prescription.

The amendment passed overwhelmingly, allowing the bill to move forward to a final vote, where it passed, 112-5.

The bill now moves to the Senate for consideration.

Cover photo Okko Pyykkö, flickr creative commons

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...