A Tough Choice to Swallow

Cancer patients lose out on more than just the comfort of taking treatment at home when the costs of their oral medications aren’t fully covered.

Thanks to the growing number of medicines available as tablets, liquids or capsules, today many patients no longer need to leave home to receive cancer treatment. These medicines can save patients time, money and trouble, and they may even boost the effectiveness of therapy.

Although patients have traditionally received therapy through intravenous (IV) infusions, people with lung cancer, prostate cancer, leukemia and several other tumor types can now choose oral alternatives. And the number of these treatments will continue to increase, since more than a quarter of cancer medications under development fall into this category.

Don Wright, who has been living with multiple myeloma for more than a decade, told Formulary that his latest oral medication has offered him hope and freedom. “I am free to take it with me wherever I go. I live my life almost as if there were no cancer, without frequent clinic visits for intravenous infusions of chemotherapy and, in my case, without disabling side effects. Indeed, the freedom afforded by this drug has allowed my family and me to run 72 marathons since my diagnosis, including one in each of the 50 states, a goal I completed in December at age 71. Now I’m focused on breaking the century mark, more than 100 marathons.”

Despite the advantages of pills, insurance company practices often compel patients to settle for more inconvenient treatments. That’s because they typically cover oral therapies as a pharmacy benefit rather than a medical benefit, meaning individuals often have to pay a greater fraction of the bill because of higher deductibles, co-payments and other costs. As a result, patients may only be able to afford intravenous or injectable therapies.

While more than 20 states have now passed laws that require equal coverage for oral chemotherapy, no such laws protect patients in the remaining states.­ Being blocked from a conveniently administered form of medication has drawbacks that many people don’t initially realize. At-home treatment doesn’t require repeated trips to a hospital or clinic. Given that each visit can average between 90 minutes and five hours, oral therapy saves patients and their caregivers’ time. It also cuts their costs by reducing travel expenses, such as highway tolls and parking, and by decreasing lost work, especially for hourly employees or those who have limited sick leave. Employers can also gain because they may not need to hire replacement workers or foot the bill for short-term disability.

Receiving therapy in a hospital or treatment facility also contributes to healthcare costs. From the costs of supplies, such as IVs and needles, to the expense of paying for physician and nurse salaries, as well as lab tests, it’s estimated that IV treatments cost $47 more a day than oral drug therapies. Annually, that amounts to $17,000 more spent on treatment.

Oral therapies can be at least equally effective, and their benefits go beyond fewer needle sticks. In fact, compared with IV treatment, oral therapy can be a more effective way to fight cancer for some patients, because the medicine remain in patients’ bodies over a prolonged period. Not surprisingly, most patients say they prefer oral medications, which cause fewer disruptions to their daily lives and which avoid the potential discomfort of an injection.

To support patients in states without oral parity legislature, you can contact your members of Congress to back the Cancer Drug Coverage Parity Act. In this era of medical innovation, it’s important to go the extra mile so patients can live longer, better lives.