For years, the mainstay of cancer treatment has been intravenous chemotherapy, which is typically covered as part of a patient's medical benefit. As the science of treating cancer has progressed, the utilization of oral chemotherapy for oncology patients has grown in significance.

Today, approximately 50 percent of the patients receiving chemotherapy do so in an oral form. Oral chemotherapy's expanding role in the treatment of cancer is rooted in science. The decision to utilize an intravenous or oral chemotherapy agent is solely based on expected outcomes, not the convenience of administration.

Unfortunately, oral chemotherapy is presenting obstacles for oncology patients since the treatment is typically covered as part of the prescription drug benefit. This fragmented coverage means that oncology patients normally will experience significantly different out of pocket costs based upon how their treatment is administered.

This difference has no relationship to how much the therapy costs or how effective it may be but whether it is in an oral form or is delivered intravenously in a medical setting. The fragmentation of the oncology benefit is an example of where insurance benefit design has not kept up with the science of cancer treatment.

My legislation, House Bill 623, would address the problems cancer patients are facing because of fragmented benefit design.

Specifically the Bill establishes a new section in the Insurance Company Law entitled Oncology Benefit Design to:

• Require insurers that provide coverage for both oral and intravenous chemotherapy to do so on equal terms and prohibit different out of pocket costs for enrollees based on how the chemotherapy is administered.
• Define the scope of affected policies to capture all policies that offer prescription benefits directly or through some affiliated entity. This language protects those consumers that believe that they are purchasing comprehensive coverage from an insurer.
• Prevent insurers from raising out of pocket costs for enrollees in order to achieve compliance with the law. This provision is particularly important to those individuals that may receive chemotherapy treatment when the new provisions of the law take effect or their policy is renewed.

Above all, my bill would ensure that all cancer patients, no matter their background, have access to the highest quality of care available. If you agree that the state legislature should pass my legislation so that all cancer patients receive the care they need, please sign my petition urging my colleagues to take action on H. B. 623.