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New Law to Increase Access to Chemotherapy Pills

Patty Wight

Cancer treatment has traditionally involved intravenous chemotherapy. But that's starting to change. Research has shown that chemotherapy pills can be more effective. The problem is that chemo pills can cost thousands of dollars per prescription, which puts them out of reach for some patients. But a new law in Maine will soon change that.

Donna Brookings has fought cancer twice. The first time was in 2005. It was breast cancer, and once a week she would go to the hospital and sit in a chair for 3-4 hours while intravenous chemotherapy pumped into her veins.

"But then I would miss two or three days of work," Brookings says. "I was only able to work part time if I was able to work at all."

After six months of treatment, she was cancer-free. But a few years later in 2013, Brookings was diagnosed with cancer again. This time, it was non-Hodgkin lymphoma.

"And my doctor had said oral chemotherapy was best," she says, "but there was no way we could afford the co-pay."

Because the co-pay for those chemo pills would have cost Brookings $4,800 a month. Intravenous treatment was cheaper, but it still wasn't a viable option because Brookings had a new job. She says she knew she'd lose it if she had to miss work like the last time she did intravenous chemo. She couldn't afford the recommended treatment or losing her job.

"And I looked at my husband and I said, 'This is it. If they can't do an oral form, then I can't miss work and do this.'" Brookings says. "I said, 'You know, it'll just be what it is.'"

Credit Patty Wight / MPBN
Dr. Nicholette Erickson

"Of all the reasons to make a decision to pursue treatment or perhaps not pursue treatment, you would hate to think that the first reason on their list was the price," says Dr. Nicholette Erickson, an oncologist at Central Maine Medical Center. She says increasingly, oral chemo drugs are the go-to treatment because they're more effective than IV treatments.

"We're getting smarter about how we're trying to treat this disease," Erickson says. "So, typical chemotherapy medicines don't tend to be very selective."

That's because they attack both cancerous and healthy cells. Chemotherapy pills, on the other hand, tend to target just the cancer cells. They're more convenient because patients can take them at home. But the co-pay is often much higher than for intravenous chemo. The reason, says Hilary Schneider of the Maine branch of the American Cancer Society, is that under insurance plans, IV chemotherapy is considered a medical benefit. Oral chemotherapy is considered a pharmacy benefit.

Credit Patty Wight / MPBN
Hilary Schneider

"So typically, somebody will pay an office visit copay for IV chemotherapy are around $30, $40, maybe," Schneider says. "Then under the pharmacy benefit, oral chemotherapy is often covered as a specialty tier drug, so people are paying $900 to thousands of dollars — $4,800 a month."

In Maine, that's changing. A new law requires insurance companies who already cover IV chemotherapy to cover chemo pills at the same level by the first of next year. Premiums aren't expected to rise that much. Schneider says a study by the American Cancer Society of more than two-dozen states with similar oral chemotherapy access laws found the largest — if any — increase in premiums was 50 cents a month. And she points out that IV chemotherapy already comes with associated costs.

"There's the cost of the nurse who's administering the treatment," Schneider says. "There's all of the additional — the supply cost, the room cost for when the patient is there. So all those costs add up."

Brookings ultimately found access by participating in a drug trial. She says she still felt nauseous with the pills, but over the course of nine months of treatment, she only missed about 50 hours of work. And she's now cancer-free.

"I was able to maintain my job," Brookings says. "I was able to still do some of the activities I like to do — not much, but I was able to be around family."

Schneider says chemotherapy pills are the drug of the future, treating at least 54 different types of cancer.