KHI News Service

Insurance lobby opposes cancer-coverage mandate

But Wichita senator wants equal coverage for chemotherapy pills

By Dave Ranney | February 10, 2010

Insurance lobbyists today testified against a bill that would require health insurers to cover oral chemotherapies the same way they do intravenous chemotherapies.

The bill would add to the companies' costs, raise customer premiums, be difficult to administer, and open the door to other mandates, the industry spokesmen said.

“If I’m not doing something now and you tell me I have to do it, that’s a mandate,” said Bill Sneed, a spokesman for America's Health Insurance Plans, appearing before the Senate insurance and Financial Institutions Committee.

The insurance industry in Kansas has generally opposed any coverage mandates.

Earlier this year, Sen. Susan Wagle, R-Wichita, introduced Senate Bill 195 after learning that many insurance policies cover intravenous cancer medications but not those in pill form.

The two, she argued, should be covered equally.

“The problem is that these drugs (pill form) are covered as part of a pharmacy benefit package rather than as a traditional medical benefit,” said Wagle, a cancer survivor.

Most pharmacy benefit packages, she said, do not cover chemotherapy drugs. Those that do, often require upfront payments of 30 percent to 50 percent. In some cases, patients are expected to pay thousands of dollars upfront with the understanding their insurer will reimburse for its portion later.

Major medical policies almost always cover intravenous chemotherapy.

Brad Smoot, legislative council for Blue Cross and Blue Shield of Kansas and Blue Cross Blue Shield of Kansas City, said that while the bill was “obviously well-intended” it would add to company costs, resulting in raised premiums.

Inevitably, he said, as premiums increase, a number of small business owners decide they can no longer afford to insure their workers.

Smoot told committee members that large employers’ so-called “Cadillac plans” already cover oral chemotherapies and, most likely, would not be affected by the mandate.

But smaller companies’ with “Chevrolet plans” that cover a percentage of a beneficiary’s prescription-drug bill would experience dramatic increases in premiums. Many, he said, would then find health insurance unaffordable.

“Your constituents,” Smoot said, “would be forced to purchase Cadillac pharmacy benefits for some drugs when all they really want or can afford is Chevy coverage.”

For many of these drugs, he said, a one-month prescription costs more than $1,000.

Though no one on the committee spoke in favor of mandates, Sen. Chris Steineger, D-Kansas City, said he was troubled that insurers seemed more concerned about their bottom lines than their beneficiaries’ health.

Sen. Karin Brownlee, R-Olathe, asked how much premiums would increase if the bill became law. Such a calculation, she was told, wasn’t available and would be difficult to construct.

The committee is not expected to work the bill until later this month.

KHI News Service

Lisa Covington of Lenexa listens to testimony in opposition to a bill that would require health insurers to cover chemotherapy pills the same way they do intravenous chemotherapies. Covington has been fighting breast cancer the past nine years.

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Lisa Covington, who’s been fighting breast cancer for nine years, attended the hearing.

“What I didn’t hear today is how when you find out you have cancer and you have health insurance you expect to be covered and you want the best of whatever’s available,” she said. “You want it because you want to live. You expect your coverage to mean something.”

Covington, 40, said her cancer treatments forced her and her husband to file “medical bankruptcy” in 2008.

“We were OK when we were on Blue Cross, but then we got switched to Coventry and that wasn’t OK,” she said. “We’re back on Blue Cross now.”

She declined to identify her or her husband’s employer.