We all (ok, 80+% of us, including our employers) pay for health insurance so that we have it when and if we need it. And, we expect that insurance to cover our costs (less a deductible), when we do need it.
Which is why many folks were angry with the Avastin (Bevacizumab) decision that the FDA made. It turns out that Avastin, a drug that blocks angiogenesis (the formation of new blood vessels [which are critical to feed and nurture cancer cells]), may not be that critical an adjuvant. It is used in conjunction with other anti-cancer drugs for colon, lung, breast, and kidney cancers, to amplify their affects. However, when it comes to breast cancer, the initial data (the data the FDA considered to render its approval) is not quite indicative of the true benefits (or lack thereof). As such, the drug is no longer considered to be part of an approved breast cancer regimen. Which means that one can still take the drug- but that one’s health insurance will not cover its costs.
But, it turns out, many health insurance companies don’t cover the costs for a whole lot of chemotherapy. No, I’m not talking about the lifetime caps some insurance products have in place (and which the new health care insurance law eradicates). But, the fact that unless certain drugs are administered IV (intravenously) or via injection, their costs are not covered.
Insurance companies have decided that oral cancer drugs (in pill form) do not require full coverage. These new drugs are typically those directed at specific cellular pathways, and have fewer side effects (nausea and hair loss, among them). One can lead a virtually normal life, in spite of the cancer diagnosis. They are often superior to alternative treatments, except for the fact that the patient ends up paying the bulk of the tab for the drugs.
Taking that same drug via injection (assuming one does exist) does get you insurance coverage, though. If you live in DC and 13 of the 50 states, that is not the fact- but Maryland and Virginia are not among those for which anti-cancer pills get coverage. Most importantly, most patients don’t find out about this problem, until it’s too late. (Notice, you can take the pills at home; taking them IV, you have to wait in a hospital, which means more worktime lost.)
It’s time for this policy to be changed.
I definitely didn’t help, Roy! I stay far away from issues of insurance because I prefer not to get annoyed. We were lucky that through Gary’s union he had excellent insurance and we still paid quite a bit out of pocket but we did not have to fight to get what he needed for treatments or wonder how we were going to pay for his medication which is just a whole other kind of stress to contend with on top of a cancer diagnosis.
Thank you for creating awareness around this issue so that people can research it more and find out ways to impact policies. It seems illogical to not cover a pill that has fewer side effects, less lost work time by survivors and caregivers plus all the other associated costs that come with heavy duty chemo. But I’ve given up expecting logical thinking from arenas such as politics, insurance and the financial industries a long time ago. I focus on the difference I can make instead.
Tambre Leighn/coaching by tambre recently posted..The Very Last Time
My hope is the more aware of these items we are, Tambre, the more we can change them. At the very least, one would know the ramifications of taking the pill over the IV- one may continue to work, but one now has a bill that will probably eat up the revenue made by working.
Roy
There is so much confusion, loop holes and nonsense with insurance. It’s very frustrating just at a time when you need the least amount of extra crap in your life. This stuff really needs to be simplified some how.
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Couldn’t have said it better myself- and I didn’t- Bonnie.
What the hell? Why punish people for taking something safer, less lost work time, less medical workers involved? Could it be that the insurances companies want people more dependent on medical health professionals to the detriment of a person’s health? Wow this is beginning to sound like the war on drugs. All the people involved in that war would go broke if drugs were made legal. Who remembers Prohibition? That time the US created organized crime.
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I can give you a few reasons- with which none I agree.
1. Taking a pill may leave you with side effects that occur when you are alone. (Or, you may have them when you are surrounded by folks at work- making money.)
2. The pills are currently more expensive. (Only if the hospital stay is free.)
3. Control of health care. (They don’t mention this- but that’s the prime reason, in my mind.)
And the challenges are not just with health insurance – all insurance companies are looking at how they can avoid paying out.
And then we could look at the money making trying to cure cancer and how ineffective so much of it is. Cancer has become a catch all medical term for all kinds of things and I think the medical incompetence is HUGE when it comes to treating cancer.
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Cancer is scary enough- without having to deal with how to pay for its treatment. Right you are, Roberta.
Roy
Tambre said it best, whenever I hear about insurance and insurance companies I get ‘annoyed’. Where is the common sense in our government … it amazes me how there is this kind of separation that just seems it leans towards the higher cost of health care instead of the more common sense approach. uugghh!
Lynn Brown recently posted..The Perfect LinkedIn Profile Picture – Uncovered!
Yes, this is why the system needs modification, Lynn. Imagine the exasperation on the patient who thought they could keep working while dealing with the life threatening illness of cancer.
Roy