National Patient Advocate Foundation Cautions California Lawmakers and Governor: Amendments to Oral Cancer Bill Significantly Increase Cost of Treatment, Will Detrimentally Impact Vulnerable Segment of Patient Population

Sep 06, 2013, 11:41 ET from National Patient Advocate Foundation

$200 Co-Pay, Annual Increases Create Hidden Costs for Too Many, says NPAF

Statistics Show When Co-Pays are Unaffordable, Patients Abandon Treatment

SACRAMENTO, Calif., Sept. 6, 2013 /PRNewswire-USNewswire/ -- Citing the hardships certain to be faced by a population of California cancer patients on strained incomes, the National Patient Advocate Foundation (NPAF), a national non-profit organization providing the patient voice for legislative reform at the state and federal levels, pulled its support for AB 219 following amendments passed in the California state senate yesterday that would prohibitively increase the co-pay for oral cancer treatment.

"The National Patient Advocate Foundation has remained steadfast in support of AB 219 in its original form that capped co-pay for oral cancer treatment at $100, thereby giving access to potentially life-saving cancer treatment to those who are struggling financially or many who have already exhausted their resources due to out-of-pocket expenses for expensive medical care," said Nancy Davenport-Ennis, Founder and Chairman of the Board of Directors for the National Patient Advocate Foundation (NPAF) and the Patient Advocate Foundation (PAF) and a two time cancer survivor. "Two thirds of the families that contact the PAF have a household income of less than $23,000 per year. Increasing the co-pay for oral cancer treatment will lock out a segment of California cancer patients who are in desperate need of care and will now be put in the position of having to forgo treatment due to cost – a predicament none of us would want for ourselves or our loved ones."

Assembly Bill 219, Access to Cancer Treatment Act, as introduced by Fresno based Assemblyman Henry Perea, would lower the monthly cost for chemotherapy pills from as much as $4,000 for each prescription to no more than $100. In addition to raising the co-pay to $200, the amended bill would increase the cap annually, tying it to the state's consumer price index and quickly moving the actual cost of the cap much higher than $200. These two measures present a hidden cost that patients will ultimately have to bear and may price patients out of their own prescribed anti-cancer treatment. New York, Florida and Texas and 23 other states have passed laws that make orally administered anti-cancer medications more affordable. No other state has included annual cost increases.  

"Patients have been fighting the battle for $100 co-pay for oral chemo for years now and it is ironic that California, a state that often provides leadership for the rest of the country, has not yet made the best decision for many cancer patients who struggle not only with their disease but with the resources to help stop it from taking their lives," said Joan Venticinque, a two-time cancer survivor and member of the NPAF President's Council. While the amendment to AB 219 that increases the co-pay cap to $200 stands to help many cancer patients with their out-of-pocket expenses, still many are left behind watching access to oral anti-cancer medication slip out of their reach."

Cancer patients find significant quality of life benefits that oral anti-cancer drugs can provide over intravenously (IV) administered chemotherapy. These new anti-cancer oral medications target specific cancer cells, resulting in a more efficient method of treating cancer.  Between 25% and 30% of new anti-cancer treatments are orally administered and for many of them, there are no infusion alternatives.

NPAF has advocated for coverage parity for oral chemotherapy in states across the country.  Many insurance plans require patients receiving intravenous chemo to usually make small co-pays for each treatment, however, patients preferring to use the pill form for chemotherapy face prescription medicine policies that often require thousands of dollars out-of-pocket each month, exhausting their financial resources and forcing difficult decisions about continuing treatment. An April 2013 cost analysis of AB 219 conducted by the California Health Benefits Review Program reported that patients with cost-sharing greater than $90 per month were significantly less likely to adhere to their treatment than patients with much lower cost-sharing. Additionally, a 2011 analysis by Avalere Health showed that when cost sharing  is $100 or less, patients are significantly less likely to abandon their treatment.  

A real danger lies in the future of their health when a cancer patient has to stop taking his chemo medication because he simply cannot afford the out-of-pocket expense. Tebbie Afshar, an NPAF volunteer from San Jose, worries for the health of her 38-year-old friend who is facing his second incidence of cancer and is no longer able to work. His wife must choose between caring for him and their four-year-old son and working herself. "He relied on oral anti-cancer medications for his treatment," Tebbie said. "He's now literally fighting for his life and for his family $100 makes a difference. With annual increases like the ones in this amended bill, his treatment will quickly become unaffordable."

AB 219 will be read for the third time in the Senate with the new amendments formally added today. If passed, the amended version would still need to be approved by the State Assembly by the end of the session this Friday, September 6th, and then signed by Governor Jerry Brown before it becomes law.

"We congratulate Assemblyman Perea on putting together a bill that will surely come as good news to some patients with very high co-pays," said Larry Lanier, NPAF President.

"Unfortunately, a $200 co-pay cap that is tied to annual increases is still too high for many patients who are already being forced to abandon their cancer treatment because of prohibitive cost. From the first day, our mission has been to serve as the voice and advocate for all patients battling illnesses, particularly those who often have not the strength or resources to champion their own cause. We ask Governor Brown and California state lawmakers to stand with us and recognize the benefit given to so many people with cancer by preserving the $100 co-pay for oral chemo without an annual cost increase," said Davenport-Ennis.

National Patient Advocate Foundation (NPAF) is a national non-profit organization providing the patient voice in improving access to, and reimbursement for, high-quality healthcare through regulatory and legislative reform at the state and federal levels. NPAF translates the experience of millions of patients who have been helped by our companion, Patient Advocate Foundation, which provides professional case management services to individuals facing barriers to healthcare access for chronic and disabling disease, medical debt crisis and employment-related issues at no cost.

SOURCE National Patient Advocate Foundation