Legislation that would require health insurers to cover chemotherapy equally, regardless of whether it was given intravenously or in pill form, passed the state Senate late Thursday evening and is being sent to the House.
The bill was drafted to address an inequality in cancer care: Many patients who receive chemotherapy through an infusion have their care covered by insurance or pay a copayment for their office visit, whereas pills often have higher out-of-pocket costs. The disparity has grown in importance as the trend in cancer drug development has meant a surge in treatments administered as pills. According to the Leukemia & Lymphoma Society, eight of 11 chemotherapies approved since 2010 are given in pill form.
Senator Stephen Brewer, who sponsored the bill, said that the Senate had been awaiting the outcome of a financial assessment prepared for the state Division of Health Care Finance and Policy. That report found that requiring parity in coverage of chemotherapy would have minuscule effects on health care premiums, resulting in an estimated 0.008 to 0.044 percent increase over the next five years.
"As soon as we got that review . . . we realized this is eminently affordable,'' Brewer said. "This is about trying to keep up with technology. It has minimal costs, and it's clearly the right thing to do.''
Jack Whelan, a 64-year-old from Andover who was diagnosed six years ago with a rare and incurable form of blood cancer, said that he has seen firsthand the disparity. Earlier on in his cancer treatment, he would receive infusion chemotherapy that was fully covered by his insurance, despite the fact that the cost was around $24,000 per visit.
Now, he said, he receives an experimental drug through a clinical trial: three pills that he takes every other week. Although he does not pay for the drug, because he is in a trial and says those costs are covered by Dana-Farber Cancer Institute and the pharmaceutical company, he knows that if the drug were approved, he would shoulder 30 percent of the cost of the drug, an estimated $270 to $670 per pill.
"The benefit of not having to sit in the infusion room connected to an IV pole, and going into a health care facility where already you're immunocompromised," Whelan said. "The idea of staying at home and taking a pill is not only convenient but safe," as well as less expensive, he said.
Lynne Graziano Morin, a spokeswoman for the Massachusetts chapter of the Leukemia & Lymphoma Society, praised the Senate's action and said that it could make a big difference for patients. She has heard stories of people skipping doses or not taking a drug because of the expense.
"We're just saying if they're already covering IV therapies, we want them to cover the oral therapies the same," Morin said.