Oral or IV Therapies: Patients with Multiple Myeloma Should Have Equal Access

Treatment choices should be based on effectiveness not coverage.

Since Amy Wolverton was diagnosed with multiple myeloma in 2008, she has been on numerous chemotherapy regimens. When one treatment stopped working, her doctor would recommend another. Sometimes the new treatment would be administered intravenously (IV); other times it would be a pill. Like many cancer patients, Amy has faced hurdles with insurance coverage for her cancer treatment.

During this year’s Multiple Myeloma Action Month, Wolverton wants people to know that some insurers are charging patients with cancer more for oral therapies (pills) than for IV therapies due to differences in how the two forms are covered. Intravenous chemotherapy falls under medical benefits, but oral cancer therapies are included in prescription medication benefits, which have much higher cost sharing for patients. As a result, some patients are forced to make treatment decisions based on their out-of-pocket costs rather than what is best for their health and survival.

“It makes little sense to me,” Wolverton said. “When you add up the medical supplies, doctors’ and nursing costs, facility overhead, and costs for complications such as infections from IVs, the insurance companies could be paying more for the IV than they pay for the pills.”

AMY WOLVERTON’S (CENTER) PARENTS, JANICE AND LEE BURKHEAD, HAVE BEEN SUPPORTING HER THROUGHOUT HER JOURNEY WITH MULTIPLE MYELOMA TREATMENT.

AMY WOLVERTON’S (CENTER) PARENTS, JANICE AND LEE BURKHEAD, HAVE BEEN SUPPORTING HER THROUGHOUT HER JOURNEY WITH MULTIPLE MYELOMA TREATMENT.

The Rise of Oral Chemotherapy

Over the past decade, Wolverton has seen the progress made in multiple myeloma and the increased availability of oral therapies. In 2017, nine of the 16 cancer treatments approved by the U.S. Food and Drug Administration were oral therapies. For many oral therapies, there is no IV equivalent. And, for some patients with blood cancer, a pill may be the only option.

When she was on an oral cancer treatment, Wolverton took a pill at home each morning and continued her routine, working full-time as a corporate government affairs executive in the telecommunications industry and spending time with friends and family, including with her mother Janice, her father Lee, her brother Jason, sister-in-law Carla, and her nephew Dylan, who is now 10.

Like many patients with multiple myeloma, Wolverton has had to find new therapies as each consecutive treatment stopped working for her. “It’s frightening and frustrating when a treatment stops working,” Wolverton said. “But, even though we have yet to find a more curative treatment for myeloma, we remain hopeful with all the new treatments, both oral and IV, that have been approved.”

I’m doing everything I can to help others with multiple myeloma and other cancers get the best possible treatment for themselves.

Oral Parity Protects Patients

Wolverton strongly believes that all patients with multiple myeloma should have equal access to all treatments, regardless of how they are taken. Most state lawmakers agree, and they have taken action.

Since 2008, the year that Wolverton was diagnosed, 43 states and the District of Columbia have enacted oral parity laws, which make the patient’s financial responsibility for covered medications equal for IV and oral therapies. Meanwhile, the Cancer Drug Coverage Act  has been introduced in the U.S. House of Representatives to protect the millions of people with plans that are not state regulated, including most plans offered by large employers.

AMY WOLVERTON AND HER NEPHEW DYLAN TAKE A SELFIE TOGETHER.

AMY WOLVERTON AND HER NEPHEW DYLAN TAKE A SELFIE TOGETHER.

With her background in legislative issues, Wolverton knows how those laws can help patients. She continues to advocate for these policies, joining the International Myeloma Foundation in its activities. She believes it’s her job to speak up for everyone who struggles to get affordable access to oral cancer treatments.

Over the years, Wolverton has switched insurance companies and experienced changes in out-of-pocket treatment costs. But, she is doing well on her current medication and remains optimistic about her future. “I’m just so grateful to be here,” she said. “And I’m doing everything I can to help others with multiple myeloma and other cancers get the best possible treatment for themselves.” 

To learn about how Congress can act to protect Americans from outdated insurance policies, read “Why Federal Oral Parity Legislation Is Urgently Needed Today.”