Bill Could Ease The Financial Burden For Families With Cancer Patients

In recent years scientists have developed anti-cancer drugs that can be taken orally, reducing the need for intravenous chemotherapy treatments. But health insurers don’t cover those drugs the same way they do chemotherapy, leaving families of cancer patients with enormous medical bills. Now, lawmakers in Annapolis want to level that playing field. And they’ve named the bill for the late wife of one of their own. WYPR’s Joel McCord has the story.

Kathy Mathias lived for 14 years with breast cancer before succumbing last August. In the last four years, after doctors conceded they couldn’t cure her, they recommended an oral medication that would help her. But her husband, Senator Jim Mathias, a Worcester County Democrat, says the co-pays were astronomical.

“Fifteen-hundred dollars every two weeks, three thousand dollars every two weeks.”

Delegate Shirley Nathan Pulliam, a Baltimore County Democrat and registered nurse, says the problem lies in the way health insurers cover the different treatments.

“If you are getting intravenous, again, it is under your medical plan, if you are getting it by oral, it’s under your prescription, or pharmacy, plan. And that’s where the difference is in terms of the out of pocket cost.”

She is the lead sponsor on the House version of the Kathleen A. Mathias Chemotherapy Parity Act of 2012. Senator Catherine Pugh, a Baltimore City Democrat, is the lead Senate sponsor.

The measure would require health insurers to cover all cancer treatments equally.

Dr. Martin Edelman, director of solid tumor oncology at the University of Maryland’s Greenebaum Cancer Center, told a news conference yesterday that advocates aren’t looking for a new benefit, but truth in advertising.

“When you get your health plan that’s going to cover cancer care it covers cancer care and not some archaic formulation of what that care is.”

Under that “archaic formulation,” patients receiving intravenous infusions of cancer drugs usually are charged the co-pay for an office visit, maybe twenty or thirty dollars. But under prescription plans, a cancer patient pays 10 percent or more for drugs that cost as much as $9,000.

Anthony Lacey, whose wife, Katrina, had breast cancer, said they maxed out their credit cards, maxed out everything.

“It was just a survival. We were going to do anything to get my wife the treatment, to get her what she needed, at any cost. We just sacrificed everything. And like I said, unfortunately, last June she passed.”

The bill has bi-partisan support in both houses, but there is a hitch. The national health care system is in flux as the federal Affordable Care Act is slowly phased in. And it isn’t clear how the requirement for parity in insurance payments will fit into that scheme.

Kimberly Robinson, of the League of Life and Health Insurers of Maryland, said her organization is worried the bill might not fit at all.

“And that’s a concern for us because insurers will have to change systems and possibly have to change them again in 2014. So trying to make sure whatever the state does will work consistently going forward as benefits develop in the state of Maryland.”

Senator Mathias, who would have celebrated his 34th wedding anniversary in March, said he is sure lawmakers will find some way to work it out. He said he has been strengthened by the honor of the bill being named for his wife.

“Although she helped shepherd us in this fight to bring hope and to bring a positive impact on the disease, she continues forward with us. This is not about her; this is about her helping other people.”

Kathy, he said, continues to inspire him.

I’m Joel McCord, reporting in Annapolis, for 88.1, WYPR.