IN THE NEWS - The Wall Street Journal - NY bill would reduce costs on oral chemotherapy

ALBANY, N.Y. — Megan Bonstein says modern health care has provided her oral chemotherapy in a pill to fight her leukemia, but modern health insurance has failed her.

"Ten years ago, that was a very grim diagnosis," the 26-year-old Columbia University social work major said of her cancer, leukemia. But advances since then — and since her own diagnosis in early 2009 — like oral chemotherapy have worked. For many cancer patients, the pill form provides a way to trade hospital intravenous treatments, hair loss and nausea for a dose taken in their own home, on their own schedule.

Traditional chemotherapy is categorized as a major medical treatment, resulting in little out-of-pocket cost to patients. But oral chemotherapy can cost a patient up to $11,000 a month after he or she quickly exceeds coverage for pharmaceuticals that are categorized as a prescription.

A bill supported by the American Cancer Society and the Roswell Park Cancer Institute in Buffalo would make New York join at least nine other states and the District of Columbia to require that traditional and oral chemotherapy to be priced similarly. Those states include Texas, Oregon, Indiana, Vermont, Hawaii, Iowa, Kansas, Minnesota and Colorado, Bills are pending in more than 20 other states, according to national cancer groups.

"Suddenly, I was panicking," said Bonstein. "Where was I going to get $11,000 a month?"

Each new addition to coverage that may affect few patients comes with a cost to all people who are insured or the governments that provide subsidized insurance.

"Often health insurers are cast as the bad guys," said Leslie Moran, senior vice president of the New York Health Plan Association. "But our human desire to have the broadest, unlimited overage with very limited financial cost to us, those two goals really contradict one another. You just can't have insurance that's all encompassing and one that keeps premiums affordable."

The political pressure to expand expensive coverage that often serves a few is in conflict with government mandates to reduce the cost of health insurance so more people can be protected.

Moran said dozens of bills in New York each year often project an added cost to all insurers of just 1 percent, but those percentages add up quickly and can make health insurance too expensive for employers and families.

For example, last year, then-New York Gov. David Paterson vetoed a bill he supported that would require New York insurers to cover screening, diagnosis and lifetime treatment for autism spectrum disorders. But he said the $70 million cost to state and local governments just for their employees was unaffordable for taxpayers in the fiscal crisis.

Moran also said a New York law may put the state in a financial bind under federal regulations now being developed as "essential benefits" under federal health care reform.

For many cancer patients, oral chemotherapy offers a welcome alternative. For others, like Bonstein, it offers life.

Her prescription coverage ran out long ago. She now is now receiving pills through the manufacturer she needs to apply for each year. The latest arrangement ends in September.

"It's very scary," Bonstein said. "I realized if it's happening to me, it's happening to other people."

Sen. Andrew Lanza, a Staten Island Republican, said the law would simply bring insurance in step with modern medicine.

"There is absolutely no reason why life-saving medicines should be covered differently simply because of the way they are administered," he said.

"We cannot allow cost to stand in the way," said Assemblyman Vito Lopez, a Bronx Democrat and co-sponsor of the bill.

The legislative session ends June 20.

JUNE 5, 2011, 1:07 P.M

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