This morning's news includes a story on a gentleman with stage IV esophageal cancer who is disputing with his insurance company to cover the costs of his treatment. He is treated at Dana Farber and is pursuing alternative treatments. I am fully supportive of efforts to prevent insurance companies from making medical decisions.
Also, I am a big fan of preventing bloated insurance costs where people expect everything to be covered and then can't understand why their premiums keep going up in leaps and bounds. There has to be a happy medium while is why insurance companies need to be allowed to draw the line somewhere.
As you are aware, I do not believe insurance companies are capable of making individual medical decisions. They may employ their own oncologists and other doctors to review decisions. But unless the doctors have met with the patient and examined them, they have no idea what they are doing. At the very least the patient's doctors recommendations should be the guidelines followed. Not someone who is reading an actuarial guide and cost/benefit analysis. That is no way to make a decision that might permanently affect some one else's life.
However, and this is a big fat HOWEVER, if the treatment has not been shown to have any proven results I do not believe the insurance providers should be required to cover it.
There are all sorts of quackery theories on curing cancer and myths about treating and curing cancer. There are also many alternative treatments that are not necessarily covered by insurance but have proven to be beneficial to cancer and other patients. This would include things like acupuncture.
The problem with this gentleman's request is that he is asking for coverage for something called Insulin Potential Therapy or IPT. I googled it and the first two results were from Quackwatch.org and from the American Cancer Society showing that their was no real proof it works.
While I understand he is fighting for his life, I am actually on the side of the insurance company here. The treatment he wants has not been shown to be effective. He has a full medical team available to him where he is being treated. While he may be feeling better currently, there is no way to tell if it can be attributed to the IPT or some other reason.
Showing posts with label insurance costs. Show all posts
Showing posts with label insurance costs. Show all posts
Oral Parity or Time to Write Your Congressman
Does anyone know what that means? When I first heard it, I needed an explanation. Oral means something to do with your mouth. Parity is something about evenness or equality (I am so smart I came up with that myself).
So what is oral parity? Its about health insurance paying for oral medications the same way they pay for in hospital infusions and other medical treatments.
You get the basics. You go to the doctor and get an IV or a shot and you pay a copay and go home. Or you go pick up your prescription and if you are lucky its a generic and costs somewhere less than $20.
But if its a brand name drug with no generic available or a new brand name drug which is considered to be a premium or Tier 37.8 (or whatever term the insurance company wants to call it to make you understand its EXPENSIVE). That means your co-pay will be something that puts a significant dent in your wallet. My copays max out at 35% of the cost. I have gotten the $100+/month prescriptions and am on one now. If I go through mail order, its a paltry $95 per month.
I think I have blogged about this before but it is increasing in importance. Currently 1/4 of all cancer drugs in development are planned as oral medications. So if a new cancer drug costs $100,000 per year and a patient needs to pay 35% of that? You can do the math.
The results is doctors are less likely to prescribe the expensive oral drugs or patients go bankrupt or just don't fill their prescriptions. To get affordable cancer care, a patient needs to get an IV infusion which is stressful, time consuming, and probably not the most advanced treatment available.
For the third time, a bill is going through Congress:
"The Cancer Drug Coverage Parity Act of 2013 (HR 1801) seeks to amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 "to require group and individual health insurance coverage and group health plans to provide for coverage of oral anticancer drugs on terms no less favorable than the coverage provided for anticancer medications administered by a health care provider." Companion legislation must be introduced and passed in the Senate before the bill can become law."
You know how agreeable Congress is these days. Maybe its time to write your Congressman/woman.
So what is oral parity? Its about health insurance paying for oral medications the same way they pay for in hospital infusions and other medical treatments.
You get the basics. You go to the doctor and get an IV or a shot and you pay a copay and go home. Or you go pick up your prescription and if you are lucky its a generic and costs somewhere less than $20.
But if its a brand name drug with no generic available or a new brand name drug which is considered to be a premium or Tier 37.8 (or whatever term the insurance company wants to call it to make you understand its EXPENSIVE). That means your co-pay will be something that puts a significant dent in your wallet. My copays max out at 35% of the cost. I have gotten the $100+/month prescriptions and am on one now. If I go through mail order, its a paltry $95 per month.
I think I have blogged about this before but it is increasing in importance. Currently 1/4 of all cancer drugs in development are planned as oral medications. So if a new cancer drug costs $100,000 per year and a patient needs to pay 35% of that? You can do the math.
The results is doctors are less likely to prescribe the expensive oral drugs or patients go bankrupt or just don't fill their prescriptions. To get affordable cancer care, a patient needs to get an IV infusion which is stressful, time consuming, and probably not the most advanced treatment available.
For the third time, a bill is going through Congress:
"The Cancer Drug Coverage Parity Act of 2013 (HR 1801) seeks to amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 "to require group and individual health insurance coverage and group health plans to provide for coverage of oral anticancer drugs on terms no less favorable than the coverage provided for anticancer medications administered by a health care provider." Companion legislation must be introduced and passed in the Senate before the bill can become law."
You know how agreeable Congress is these days. Maybe its time to write your Congressman/woman.
More on the breast cancer treatment gap
A few weeks ago I blogged about the breast cancer treatment gap where women who are told they are BRCA positive only have surgical options to lower their risk of breast or ovarian cancer. It turns out this is growing in significance because of genetic testing progress.
This started when Angelina Jolie announced she had a prophylactic bilateral mastectomy because she was BRCA positive. Unless you have been living under a rock you couldn't have missed that story in the news recently.
While many people are supportive of her decision, some are not. Here is an article on the other side of the issue - which shows how some people are not in favor of this type of prophylactic surgery. I think this kind of decision is very personal but unfortunately there are not a lot of options for those with who test for the genetic mutation.
We can also add in the fact that insurers often are reluctant to pay for the tests. Not just the BRCA test but others for Cowden's syndrome or Li-Fraumeni syndrome, both of which are shown to raise risk for breast and other cancers.
Finally, let's top this all off with the fact that University of Alberta researchers have pinpointed markers for sporadic cases of breast cancer - meaning ones without a family history. Or about 80% of all breast cancers could be caused by these markers. They suggest that women with the marker could then proceed with prophylatic options. We know what that means.
So let's add it up:
So where does that leave the patients? Over the barrel without a lot of options.
This started when Angelina Jolie announced she had a prophylactic bilateral mastectomy because she was BRCA positive. Unless you have been living under a rock you couldn't have missed that story in the news recently.
While many people are supportive of her decision, some are not. Here is an article on the other side of the issue - which shows how some people are not in favor of this type of prophylactic surgery. I think this kind of decision is very personal but unfortunately there are not a lot of options for those with who test for the genetic mutation.
We can also add in the fact that insurers often are reluctant to pay for the tests. Not just the BRCA test but others for Cowden's syndrome or Li-Fraumeni syndrome, both of which are shown to raise risk for breast and other cancers.
Finally, let's top this all off with the fact that University of Alberta researchers have pinpointed markers for sporadic cases of breast cancer - meaning ones without a family history. Or about 80% of all breast cancers could be caused by these markers. They suggest that women with the marker could then proceed with prophylatic options. We know what that means.
So let's add it up:
- Researchers are finding genetic causes to more cancers.
- Insurers don't want to pay for genetic tests.
- The only options for women with the genetic mutations or markers are significant disfiguring surgery with long term complications.
So where does that leave the patients? Over the barrel without a lot of options.
Doctors getting on the cost bandwagon
I have long been whined commented on the high price of medications. I find the high price of new medications combined with the laughable rationale given by the drug manufacturers ridiculous.
Not to put a dollar value on a human life, but a drug that costs upwards of $10,000 per month and may extend life only a few months, is crazy. You can say that few actually pay the full price but we all pay the prices in the form of higher insurance premiums.
A group of more than 100 doctors, mostly oncologists, from fifteen countries, have banded together to blast the high cost of cancer care.
"The doctors and researchers, who specialize in the potentially deadly blood cancer chronic myeloid leukemia, contend in a commentary published online by a medical journal Thursday that the prices of drugs used to treat that disease are astronomical, unsustainable, and perhaps even immoral.
Not to put a dollar value on a human life, but a drug that costs upwards of $10,000 per month and may extend life only a few months, is crazy. You can say that few actually pay the full price but we all pay the prices in the form of higher insurance premiums.
A group of more than 100 doctors, mostly oncologists, from fifteen countries, have banded together to blast the high cost of cancer care.
"The doctors and researchers, who specialize in the potentially deadly blood cancer chronic myeloid leukemia, contend in a commentary published online by a medical journal Thursday that the prices of drugs used to treat that disease are astronomical, unsustainable, and perhaps even immoral.
They suggested that charging a high price for a medicine needed to keep someone alive is profiteering, akin to jacking up the prices of essential goods after a natural disaster."
I like the word 'profiteering' for this price gouging. I mean, how do you justify these prices? If you do a cost benefit analysis as a typical business model, the company pays researchers for years to come up with the drugs. If you say 10 researchers at $100,000 (for easy math) and ten assistant researchers at $50,000 plus $500,000 in equipment for ten years, that would work out to $2 million a year or $20 million total. I know my math is not perfect but you get the idea. Even if I am off by a scale of 10 and the costs are $200 million for ten years of research.
Then take a drug that costs $10,000 per month being taken by 5000 patients that is (pause while I find a calculator) $50 million per month in income. Or in four measly months, they have made back their $200 million.
And even if my costs are off by another factor of ten and we are looking at total costs of $2 billion, they would still get their money back in forty months, or just over three years. Or if the drug is taken by 10,000 patients, they would get their money back in 20 months, or just over 1.5 years.
But I have digressed WAY OFF track. My point is I can't find any justification for the pharma industry's claims of high costs. And now the doctors are claiming them to be profiteering as well. Maybe we need a congressional inquiry - no that would be all sorts of waste of government dollars - but we do need something to make this price gouging end.
Share personal information or pay up
The claim is that it helps the company save money in insurance costs because its a preventive measure and helping people get and stay healthy. I have a real problem with this on several levels.
Its none of your insurance company's business as to what is wrong with you. This leads to bias and to loss of or lack of coverage.
Body fat percentage is not a good value to represent overall health. While my body fat percentage is probably higher than it should be, I go to the gym three times a week and get the recommended amount of exercise each week and not everyone can saying that..
Finally knowing someone's weight and body fat percentage does not get them to the doctor's office for a check up which is more important. Even skinny people need check ups.
Its no one's business what I weigh. That's between me and my scale and the doctor's office. During all my medical treatments, my husband is allowed to know everything but my weight. I am working on my personal deflabbification project. I will share I wear size 12 pants and wish I wore size 10 - that's all you need to know.
I understand the point is that insurers want healthier people but this is not the right way to do this. Find a different way. Work with the patients. Do not invade their privacy or financially penalize them. My insurance company gives us a freebie if we get an annual physical.
Those sneaky hospital costs
A new hot button issue in the world of medical treatment are the sneak hospital costs. Hospitals and insurance companies have negotiated these rates and traditionally they have been covered by insurers. But as patients switch to higher deductible policies they are bearing the brunt of these costs.
On the hospitals side, they claim they warn patients by putting signs up through the facilities where these are charged so patients are warned. But they are not told the amounts until they receive the bill. They also say these fees pay for things like twenty four hour ER stays, research, and teaching.
Medicare allows doctors to charge overhead fees for work performed in buildings owned by hospitals. So I guess this is automatically done for us non Medicare patients.
On their side, insurance companies do negotiate with the hospitals but say they can't change the way hospitals bill. (Sounds like someone might be trying to pass the buck here.)
I can understand hospitals have costs that are not included in the fee to pay to see the doctor. They are in big buildings and they provide additional services than just doctor visits. They are also trying to cover their research costs, etc. While hospitals are there to treat patients who pay the fees to get care, you can't tell me they do not get grants to pay for research which should cover the research costs?
If we get to research costs again, aren't patients also paying for the research costs for the pharma companies by receiving really expensive brand name drugs as well?
I think that this is clearly another issue that shows how badly our healthcare system is messed up and how much more change is needed.
On the hospitals side, they claim they warn patients by putting signs up through the facilities where these are charged so patients are warned. But they are not told the amounts until they receive the bill. They also say these fees pay for things like twenty four hour ER stays, research, and teaching.
Medicare allows doctors to charge overhead fees for work performed in buildings owned by hospitals. So I guess this is automatically done for us non Medicare patients.
On their side, insurance companies do negotiate with the hospitals but say they can't change the way hospitals bill. (Sounds like someone might be trying to pass the buck here.)
I can understand hospitals have costs that are not included in the fee to pay to see the doctor. They are in big buildings and they provide additional services than just doctor visits. They are also trying to cover their research costs, etc. While hospitals are there to treat patients who pay the fees to get care, you can't tell me they do not get grants to pay for research which should cover the research costs?
If we get to research costs again, aren't patients also paying for the research costs for the pharma companies by receiving really expensive brand name drugs as well?
I think that this is clearly another issue that shows how badly our healthcare system is messed up and how much more change is needed.
It was included with this article titled US Manages Disease, Not Health which states that though Obama care represents change and has the goal of helping more Americans get health insurance and access to health care. But tjhat is the wrong question to answer.
They claim the real question that healthcare reform needs to answer is: "How can we improve medical care so that it's worth extending it to more people? In other words, how can we create a health care system that helps people become and stay healthy?"
Personally I would like to believe that both questions should be answered. We need everyone to have access to health insurance and health care and we need a better medical system that helps people become and stay healthy.
As this article claims more focus needs to be on prevention and keeping people healthy where treatments are less expensive and less arduous. We do need to focus on healthier life styles. More exercise - go for a walk instead of watching tv. Provide better food - meaning less processed food, fewer ingredients.
I have seen changes which help make Americans healthier by offering free annual physicals as a preventative measure. There has also been a movement coupled with the recent recession where people are eating healthier, farmers markets are showing up everywhere, and there has been public awareness of the dangers of obesity.
But we have a long way to go. We need health care reform, we need to focus on keeping people healthy, and we need financial reform in the way doctors, medical centers, and insurance companies pay and charge fees.
New Breast Cancer Drug but at What Cost
The FDA approved Kadcyla for late stage breast cancer treatment. This is a good thing. Its about time. And it will save many women's lives.
But I have a real problem with the financials behind it. A month's treatment costs $9800 or $117,600 annually, which apparently is about twice the costs of Herceptin. These costs will mostly be covered by insurance - and we wonder why insurance premiums are going up.
Immunogen, who developed it, expects to receive a $10.5 million pay off plus royalties of 3-5% of the expected world wide sales of $2 billion (with a b). To my tiny math brain, that means they get $60,000,000 (that's 60 million if you are having problems with all the zeros).
It will be marketed by Genentech who I assume will take in the rest of the profit after coming up with snazzy packaging and fancy ads. I have no idea what Genetech's manufacturing and promotional costs will be but I am sure their profits will exceed that of Immunogen.
But that's okay because the insurance companies will probably cover most of it - which is why our medical costs keep increasing so rapidly.
Going back to when I blogged about pricing and how it is determined by marketing people, I am sure the whopping price tag was set by marketers (those evil people) who wanted it to be high end, represent a last chance for women to extend their lives, and if its expensive it must work really, really, really well.
But at least it is finally available for the women who need it who will gladly pay any price to extend their lives. Call me cynical, but maybe I am.
But I have a real problem with the financials behind it. A month's treatment costs $9800 or $117,600 annually, which apparently is about twice the costs of Herceptin. These costs will mostly be covered by insurance - and we wonder why insurance premiums are going up.
Immunogen, who developed it, expects to receive a $10.5 million pay off plus royalties of 3-5% of the expected world wide sales of $2 billion (with a b). To my tiny math brain, that means they get $60,000,000 (that's 60 million if you are having problems with all the zeros).
It will be marketed by Genentech who I assume will take in the rest of the profit after coming up with snazzy packaging and fancy ads. I have no idea what Genetech's manufacturing and promotional costs will be but I am sure their profits will exceed that of Immunogen.
But that's okay because the insurance companies will probably cover most of it - which is why our medical costs keep increasing so rapidly.
Going back to when I blogged about pricing and how it is determined by marketing people, I am sure the whopping price tag was set by marketers (those evil people) who wanted it to be high end, represent a last chance for women to extend their lives, and if its expensive it must work really, really, really well.
But at least it is finally available for the women who need it who will gladly pay any price to extend their lives. Call me cynical, but maybe I am.
Oral Parity And What Its All About
Oral parity is (in my non medical person, layman English with a touch of chemobrain and fibro fog) where an insurance company covers an intravenous medication as a hospital visit but in a pill form covers it as a pharmacy benefit and only covers a smaller portion - $2300/month co-pay in one example.
The insurance companies like it this way because its one less thing to cover. From the doctor and patient perspective its a barrier to patients receiving needed treatment. There is a big "who-haw" going on about this in the insurance world as well.
I have never understood why pharmacy benefits are so different and so separate from other medical coverage. And don't get me started on vision and dental care. These aren't optional things in maintaining good health and should all be covered equally.
But this oral parity thing should not be lumped into the same category as other medications. It highlights the problem with the pharmaceutical industrygouging over charging the American patient to 'cover their research costs and high salaries and huge employee perks still offered to all of their employees'.
If you get a new brand name prescription drug, it comes in lovely little packaging, probably has a massive marketing campaign attached to it. I had one that came with the pills were color coordinated (or vice versa) with the bottle's labeling. Another one, have more designer time put into packaging that was needed. Finally, I have one that comes with a 20 minute instructional DVD on how to apply and dispose of the patch in your introductory package from your doctor which includes a coupon to cover the copay on your first month's treatment.
In the marketing world, this is all part of branding. A new product is introduced and all parts of its packaging, positioning, pricing come into play. A marketing plan includes four P's - product, price, place, and promotion.
A target sales price tells a lot about a product. If a prescription cost $5 retail, do you think - why is it so cheap? Does it work? If a brand name orange juice is $3.99/gallon and another of the exact same product is $1.00/gallon. Would buy the cheaper one simply on price or do you think it must be lower quality and read all the packaging to see if its from concentrate? If a prescription costs $5000/month do you think 'It must work really well if its that expensive!'. Pricing implies a lot.
Next is packaging. If that orange juice comes in a carton where you can't see the product vs one in a fancy glass bottle, what do you think? Is there settling in the glass bottle that is hidden in the carton? Do you want to see the juice? Is the fancy glass bottle making it 'greener' or give more value? Same with pills, are they in a jar or those stupid blister packs (that are hard to open with RA)? Is the box with the blister pack or the jar packaged in a nice little box with all sorts of packaging and promotion and benefits of the medication as well as the warnings.
Finally, positioning is where do you want the product to have the appeal? If they show women of all ages and races in their ads for a bone density product or should they only show little old ladies who don't have the 'dowager' hump because that is what the product is supposed to avoid. They make the packaging and price and add it with the positioning to make the branding to make the high price bearable.
This takes us back to the huge problems inherent in the medical world where insurance companies and providers are making decisions. Oral parity is only a symptom.
The insurance companies like it this way because its one less thing to cover. From the doctor and patient perspective its a barrier to patients receiving needed treatment. There is a big "who-haw" going on about this in the insurance world as well.
I have never understood why pharmacy benefits are so different and so separate from other medical coverage. And don't get me started on vision and dental care. These aren't optional things in maintaining good health and should all be covered equally.
But this oral parity thing should not be lumped into the same category as other medications. It highlights the problem with the pharmaceutical industry
If you get a new brand name prescription drug, it comes in lovely little packaging, probably has a massive marketing campaign attached to it. I had one that came with the pills were color coordinated (or vice versa) with the bottle's labeling. Another one, have more designer time put into packaging that was needed. Finally, I have one that comes with a 20 minute instructional DVD on how to apply and dispose of the patch in your introductory package from your doctor which includes a coupon to cover the copay on your first month's treatment.
In the marketing world, this is all part of branding. A new product is introduced and all parts of its packaging, positioning, pricing come into play. A marketing plan includes four P's - product, price, place, and promotion.
A target sales price tells a lot about a product. If a prescription cost $5 retail, do you think - why is it so cheap? Does it work? If a brand name orange juice is $3.99/gallon and another of the exact same product is $1.00/gallon. Would buy the cheaper one simply on price or do you think it must be lower quality and read all the packaging to see if its from concentrate? If a prescription costs $5000/month do you think 'It must work really well if its that expensive!'. Pricing implies a lot.
Next is packaging. If that orange juice comes in a carton where you can't see the product vs one in a fancy glass bottle, what do you think? Is there settling in the glass bottle that is hidden in the carton? Do you want to see the juice? Is the fancy glass bottle making it 'greener' or give more value? Same with pills, are they in a jar or those stupid blister packs (that are hard to open with RA)? Is the box with the blister pack or the jar packaged in a nice little box with all sorts of packaging and promotion and benefits of the medication as well as the warnings.
Finally, positioning is where do you want the product to have the appeal? If they show women of all ages and races in their ads for a bone density product or should they only show little old ladies who don't have the 'dowager' hump because that is what the product is supposed to avoid. They make the packaging and price and add it with the positioning to make the branding to make the high price bearable.
This takes us back to the huge problems inherent in the medical world where insurance companies and providers are making decisions. Oral parity is only a symptom.
Evil, sneaky balance billing
And its legal in most states, unfortunately. Balance billing is when you use an out of network medical care provider and your insurance company covers $2000 of the $5000 bill. Then the caregiver turns around and bills you for the other $3000. How sneaky is that? But it gets worse. After a scheduled surgery you could find out the anesthesiologist, radiologist, and assistant surgeon are not part of your network could bill you for thousands of dollars.
The really super sneaky part is:
The medical care provider could be very quick to start billing you, send you to collections, and report on your credit rating.
And then sometimes your insurance company will pay all or a portion of the balance billing leaving you to undo all of the damage.
A portion of balance billing is illegal in Illinois and the is legislation in the works in New York. But if you get billed for teh balance, don't sit there, start dialing and researching to protect your bank balance and your credit rating.
The really super sneaky part is:
The medical care provider could be very quick to start billing you, send you to collections, and report on your credit rating.
And then sometimes your insurance company will pay all or a portion of the balance billing leaving you to undo all of the damage.
A portion of balance billing is illegal in Illinois and the is legislation in the works in New York. But if you get billed for teh balance, don't sit there, start dialing and researching to protect your bank balance and your credit rating.
Inequality in insurance compensation
I have often wondered why there are such inequalities in insurance compensation. What I am referring to is why is dental coverage so different than general healthcare coverage? Also, why are prescription medications so different from medical care received at hospitals.
Dental care is just as important for good health as general health care. One thing is that flossing is important in cardiac care some how. I don't know how this works but flossing is important. Oral cancers cause death and are usually found by dentists. I just find it ridiculous that dental coverage is so infrequently offered and the coverage is so poor. This is from the point of view from some one who just paid a $600+ dental bill for two fillings and two checkups - one for each of us. And we are on the Federal Blue Cross program which is supposed to be one of the best around.
Also, why are medications taken orally in pill form covered so differently than infusion type medications given in the hospital. So if you get an infection and are hospitalized and get IV antibiotics, its basically covered. But if you get a prescription for regular tablet antibiotics, you are hit with the big copay? It doesn't make sense. Especially with the recent advances in cancer treatments.
So you have cancer you go for chemo infusions and they take hours. Each chemo round costs an easy $10,000+. You go every couple of weeks. That's expensive but your insurance probably charges you a regular $20-$30 copay if you are lucky. Then you switch to an oral chemo which is a pill form that you take often - maybe every day or whatever they tell you. These are a premium brand name pill and you are hit with a big fat copay. My insurance would charge me $95/refill at the mail order pharmacy and a lot more if I got it at my local drug store. And if you got three different pills that would be three times the price. That adds up each month.
So finally here in Massachusetts there is a bill slowly making its way through the legislation that would require insurers to cover chemotherapy equally, whether IV or oral pill form. I would love to see this adopted nationally and applied to all prescription medications.
And have my dental care covered equally. (Yes, I floss every day.)
Dental care is just as important for good health as general health care. One thing is that flossing is important in cardiac care some how. I don't know how this works but flossing is important. Oral cancers cause death and are usually found by dentists. I just find it ridiculous that dental coverage is so infrequently offered and the coverage is so poor. This is from the point of view from some one who just paid a $600+ dental bill for two fillings and two checkups - one for each of us. And we are on the Federal Blue Cross program which is supposed to be one of the best around.
Also, why are medications taken orally in pill form covered so differently than infusion type medications given in the hospital. So if you get an infection and are hospitalized and get IV antibiotics, its basically covered. But if you get a prescription for regular tablet antibiotics, you are hit with the big copay? It doesn't make sense. Especially with the recent advances in cancer treatments.
So you have cancer you go for chemo infusions and they take hours. Each chemo round costs an easy $10,000+. You go every couple of weeks. That's expensive but your insurance probably charges you a regular $20-$30 copay if you are lucky. Then you switch to an oral chemo which is a pill form that you take often - maybe every day or whatever they tell you. These are a premium brand name pill and you are hit with a big fat copay. My insurance would charge me $95/refill at the mail order pharmacy and a lot more if I got it at my local drug store. And if you got three different pills that would be three times the price. That adds up each month.
So finally here in Massachusetts there is a bill slowly making its way through the legislation that would require insurers to cover chemotherapy equally, whether IV or oral pill form. I would love to see this adopted nationally and applied to all prescription medications.
And have my dental care covered equally. (Yes, I floss every day.)
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