News Feature | February 26, 2014

Wisconsin Legislation Changes Coverage For Pill Forms Of Cancer Drugs

Source: Pharmaceutical Online

By Marcus Johnson

A new bill in the Wisconsin legislature would change the way that cancer drugs taken orally can be covered by insurance companies. There have been multiple public cases of cancer patients in the state having to pay for the majority of their treatment simply because their cancer drugs were administered orally instead of intravenously. The bill already has more than 50 co-sponsors, as well as the support of multiple patient and cancer advocacy groups. Wisconsin is hoping to follow in the footsteps of states such as Iowa and Minnesota, which have already passed similar laws. As many as 26 states across the country require similar coverage for cancer drugs that are administered orally and intravenously.

University of Wisconsin School of Medicine and Public Health professor Brad Kahl believes this is the right step for the state. “To me, this is a common sense thing, said Kahl. “It’s a matter of simple fairness. It’s doing the right thing.”

Another UW medicine professor, Natalie Callander, believes that oral and intravenous treatments should be considered the same as far as coverage is concerned. But she believes that there is another issue that the medical industry, patients, lawmakers and insurers should be tackling. But this is avoiding the bigger issue — which is “how we set up a system that sets reasonable costs for drugs,” Callander said. “I feel ambivalent about this legislation because the backers include the drug companies.”

Insurers are in opposition to the legislation, and they claim that the high out-of-pocket costs have been solved by the Affordable Care Act. The ACA puts a cap on out-of-pocket costs for a patient; the cap is currently at $6,350.