From the Statehouse 2008 No. 22
by Jennifer Garrison
Jun. 26, 2008
From the Statehouse: Improving Access to Life-Saving Cancer Treatments- June 27, 2008
By Jennifer Garrison
For those undergoing cancer treatments, there are many instances where patients have the opportunity to participate in clinical trials where an experimental drug may be life-saving. Although such trials may be a patient’s only hope of survival, under current law clinical cancer trials are designated as experimental and most insurance contracts exclude coverage for experimental treatments. Effectively, those who would otherwise be insured to receive treatments and accompanying routine care or hospitalization are not covered if they opt to participate in a clinical trial.
Cancer is the number-one killer in Ohio.
Every hour, seven Ohioans are diagnosed with cancer, and three Ohioans die from the disease.
Only three percent of cancer patients enroll in the clinical trials that could save so many lives.
Substitute Senate Bill 186 requires that insurers, public employee benefit plans, and multiple employer welfare arrangements must cover the expenses for the hospital care necessitated by experimental treatments. This law does not require insurance companies to pay for the experimental treatment- this is covered by the trial itself. The clinical cancer trial must meet several requirements to qualify.
First, the experimental treatment must be approved by either the National Institutes of Health or one of its cooperative groups or centers administered by the United States Departments of Health and Human Services, Agriculture, Defense, or Veterans Affairs.
Second, the trial must have the intention of improving the health of the patient and not simply to test changes in the behavior of the disease.
Finally, the clinical cancer trial must be testing for one of the following related to a given drug, item, or health care service:
the mode of administration;
the response by the patient;
the comparative effectiveness to known drugs, items, or healthcare services;
or new uses of existing drugs, items, or health care services.
SB 186 stipulates that a patient cannot seek coverage for those aspects of care directly related to the clinical cancer trial such as the experimental drug, item, or service under investigation.
Each year, cancer threatens and even takes the lives of far too many individuals. SB 186 will encourage more cancer patients to undergo new treatments with the hope of curing themselves, while helping to develop more effective treatments without the stress and financial worries that come from the uncertainty of coverage by a patient’s health insurance provider. Therefore, I supported SB 186 as a co-sponsor of the measure and with my “yes” vote as it passed out of the House. The bill was signed into law by Governor Strickland in early May.
In that same light, the House recently approved House Resolution 100.
About half of the people diagnosed with cancer each year are Medicare beneficiaries, and community cancer clinics treat over 80% of Americans with cancer, providing patients with a number of vital services.
Unfortunately, the Medicare Prescription Drug Improvement and Modernization Act approved by Congress in 2003 created a severe reduction in the Medicare reimbursement rate for oncology treatment, especially at community cancer care clinics, with nearly all cancer treatments there being reimbursed below actual costs.
The Community Cancer Care Preservation Act of 2007, presently being considered by Congress, provides critical assistance to community oncologists that are disadvantaged by reforms brought forth by the Medicare Prescription Drug Improvement and Modernization Act of 2003.
It is important that cancer treatments continue to improve for everyone seeking care. Instead, the facilities that treat 80% of our nation’s patients have been financially immobilized by federal policies that do not work.
I supported House Resolution 100, which encourages Congress to enact the Community Cancer Care Preservation Act of 2007 in order to reform the Medicare reimbursement methodology for cancer drugs and their administration. The House approved this resolution unanimously, and it now awaits consideration in the Senate.
You can reach Jennifer Garrison at her Columbus office at (614) 644-8728, in the district at 373-2414 or by e-mail at jennifer@jennifergarrison.com. Her website is Riffe Center | 77 South High Street | Columbus Ohio 43215-6111 | (800) 282-0253 | District93@ohr.state.oh.us
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