Bill could bring down the cost of chemo for some patients

Legislation would require insurance companies to cover chemo pills

For some cancer patients, chemotherapy means the difference between life and death. That can mean several trips to the hospital and hours hooked up to an IV. But a new bill in Madison would make chemotherapy pills more affordable, meaning some people can take treatment right at home.

While IV chemotherapy is listed as a medical treatment and covered by insurance, chemo pills are considered a pharmacy benefit and are not covered. Right now, patients taking the pill form are paying tens of thousands of dollars each month out of pocket. Wisconsin legislation would force insurance companies to cover the pill the same as IV or injection chemo. Medical staff and patients think its the right decision.

Robert Konopa has brain cancer. Konopa’s been taking chemotherapy pills since his surgery last January.

“And it’s been working out. It’s been working out good,” Konopa said.

Konopa said taking the pills means he has more time at home, and because he doesn’t drive, he doesn’t need to take someone else’s time up bringing him to the hospital.

“The people in the areas, it’s like they came 50-60 miles to come and be here for the liquid chemo and I thought ‘Oh my gosh. How interesting that would be if they could have the pill or something like what I’ve got because it’s really doable,'” Konopa said.

But not all cancer patients are fortunate enough to use pills for chemotherapy.

“Some of these drugs cost between $9,000 and $12,000 just for one month of chemotherapy,” Paula Gill, medical oncologist and hemotologist at Mayo Clinic Health System, said.

“Oral chemo therapies require a lot of prior authorization. You do a lot of back and forth with the insurance company and justifying the purpose for the medication,” Susan Newman, medical social worker at Mayo Clinic Health System, said.

These added road blocks from insurance companies could even be holding back some cancer patients from a more effective treatment.

“For some types of cancers, the oral form is actually more effective then what we have in terms of the IV types,” Gill said.

“I had an MRI in November and it did look like those pills, the chemotherapy, made some of the cancer smaller,” Konopa said.

Konopa said he’ll be watching and hoping that lawmakers pass the bill.

“If they can make it a little bit better, a little easier, why not? Why not try that? So I hope it does, I hope it does go through,” Konopa said.

Health insurance companies are opposing the bill. They’ve said it will drive up their costs.

The state Assembly recently made an amendment to the bill and sent it back to the Senate. Lawmakers there have one more day in session before breaking for the year. A spokesperson from Gov. Scott Walker’s office has said he would sign the bill.