Kansas Health Institute | Information For Policy Makers. Health for Kansans.

TOPEKA — Insurance lobbyists renewed their opposition Thursday to a bill that would require health insurers to cover oral chemotherapies the same way they do intravenous chemotherapies.

Testifying before the House Insurance Committee, Bill Sneed, representing America’s Health Insurance Plans, said requiring equal coverage would blur the lines between major medical and pharmacy benefit plans, wreaking administrative havoc.

“The thing you have to remember is that an insurance policy is a contract,” Sneed said, “and what we’re talking about here are two separate contracts.”

Major medical plans, he said, cover intravenous chemotherapy; pharmacy benefit plans cover oral (pill form) chemotherapy.

“They are two different things,” Sneed said, later noting that many ordinary or so-called Chevrolet pharmacy plans do not cover oral chemotherapy because a one-month prescription may cost $5,000 to $10,000.

Additional coverage is generally available if a customer is willing to pay for it.

Senate Bill 390, Sneed said, would require insurers to provide the coverage and, in turn, require customers to pay for it.

Both requirements, Sneed said, should be viewed as mandates. The insurance industry, he said, opposes mandates.

Also, he said, most major medical plans cover a month’s supply of pills, if they are prescribed while the patient is hospitalized.

Health insurers, he said, have nothing against oral chemotherapy, but if pharmacy plans are required to include it, their coverage costs are sure to increase.

In Kansas, most large employers – including the State of Kansas – have pharmacy plans that cover oral chemotherapy while most individual and small-business plans do not.

“Those are people who have chosen to buy or provide Chevrolet coverage because that’s what they can afford,” said Brad Smoot, legislative council for Blue Cross and Blue Shield of Kansas and Blue Cross Blue Shield of Kansas City.

SB 390, he said, would force would-be Chevrolet buyers to buy a higher-priced Cadillac plan.

Smoot warned if the bill reached the House floor, it would be subject amendments for including other mandates.

The bill passed the Senate last month, 35-3.

Chirs Masoner, a lobbyist representing the American Cancer Society, testified in favor of the bill, saying it made no sense to cover one delivery method and not the other.

“The issue here isn’t whether this is a mandate, the issue is parity,” he said. “It’s the same drug – delivered one way, it’s covered; delivered another way, it’s not.”

Policy holders, he said, expect equal coverage.

Masoner called the disparity a “loophole” that insurance companies have used to “shift the burden” of ever-increasing prescription drug costs onto insured patients.

Ironically, pharmaceutical companies, he said, have programs that help uninsured patients get the chemotherapy medications they need. Insured patients, however, are expected to pay their own way and end up paying thousands of dollars out of pocket.

It’s not unusual, Masoner said, for pharmacy plans to require upfront payments of 30 percent to 50 percent.

Afterward, Kim Olson, a social worker at the cancer unit Stormont-Vail Hospital in Topeka, said it was misleading for Sneed and Smoot to imply that people know what their insurance does and does not cover.

“They have no idea,” Olson said. “They think they’re covered, their doctor gives them a prescription, they go to the pharmacy, and they’re told, ‘That’ll be $5,000,’ which, of course, they don’t have.

“They don’t know this is going on,” she said. “Most providers (physicians) don’t either.”

Committee members asked several questions of the conferees.

Rep. Cindy Neighbor, D-Shawnee, asked Smoot and Sneed if insurers would steer patients toward oral chemotherapy if it’s found to cost less than intravenous chemotherapy.

Sneed said they probably would. Smoot said Blue Cross is reviewing the cost differential now.

Neighbor said she had a hard time understanding why something that’s likely to be covered in the future shouldn’t be covered in the present.