Monday, December 11, 2017
Health

Pasco physician-turned-cancer-patient takes drug parity fight to Tallahassee

HUDSON — Dr. Wayne Taylor never had time or inclination to talk with patients about their insurance coverage. His office staff dealt with the money. He just tried to get patients healthy.

But after battling an aggressive form of leukemia, Taylor shifted his focus beyond his identity as a doctor. Which is why today, three years after that diagnosis, he plans to hear a legislative committee in Tallahassee debate something he's come to care about:

Making it less expensive for cancer patients to get their chemotherapy drugs in pill form.

Over the past five years, the pills have become the cancer-fighting drug of choice for a growing number of patients. Some of the pills have fewer side effects than the conventional intravenous chemotherapy. They can also be more convenient, especially for patients who live far from a treatment center.

But patients with insurance can owe thousands of dollars a month out-of-pocket for the oral medications, compared with a small co-payment for drugs administered intravenously at doctors' offices.

That disparity exists because of how most health insurance plans are set up: Coverage for an IV drug is usually provided as a medical benefit while oral drugs are covered as a pharmaceutical benefit. That means under many plans patients owe a percentage of the drugs' costs, with no limit on annual out-of-pocket costs.

"I realized these insurance issues aren't keeping pace with advancements in medicine," said Taylor, 54.

Companion bills in the House and Senate (HB 301 and SB 422) would require that insurers provide coverage for orally administered cancer drugs that is equivalent to that for infusion drugs.

Since 2007, 21 states plus the District of Columbia have passed similar laws, according to the Alliance for Access to Cancer Care.

Only about a quarter of oral medications have intravenous substitutes. Higher out-of-pocket costs scare patients away from the oral drugs, one large-scale study showed. In that analysis of more than 10,000 pharmacy claims for the oral medications, 25 percent of patients did not fill their initial prescriptions if they owed more than $500.

Opposition can be expected from insurers. Michael Garner, president of the Florida Association of Health Plans, said the proposals put the burden on insurers, not the drug companies charging high prices for the oral medications. He noted that many of the oral drugs are relatively new on the market.

Garner also said insurers have another worry. Insurance plans that existed before March 2010 were "grandfathered" under the federal health care law, meaning they did not have to make substantial changes. But Garner and legislative analysts said it's possible requiring those plans to alter their benefits package could trigger new requirements under the federal law.

Taylor, who has been in remission for two years and says he tires easily, has not resumed his Hudson medical practice. When he was diagnosed with acute myeloid leukemia, he ended up in a clinical drug trial at Moffitt Cancer Center, which meant his drugs were covered.

But after he finished his treatment, Taylor decided to join an advocacy group of the Leukemia & Lymphoma Society. He asked what he could do, and the group pointed him to the Alliance for Access to Cancer Care's work on the oral medication legislation. Then he started hearing stories about leukemia patients getting $9,000 monthly bills for Gleevec, the anticancer drug that he partly credits for remission of his own cancer.

Taylor has visited the offices of Pasco legislators, including House Speaker Will Weatherford, and heard objections based on potential costs and the creation of a new mandate.

He has answers for both: One study determined the legislation would cost plans no more than 50 cents per member per month. He objects to the word "mandate," because he argues the legislation isn't requiring new cancer benefits, just parity between benefits already offered.

A Tallahassee novice, he isn't sure what to expect. But he's dealt with uncertainty before.

"Doctors, we're control freaks, we're running the show," he said. "And when I got cancer, it was all of a sudden, 'Oh. I'm not running the show.' "

Jodie Tillman can be reached at [email protected] or (813) 226-3374.

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